Relax & Be Well, LLC 

Therapeutic Massage and Wellness Coaching  

Are you currently being treated?*
Did your treatment include any removal or radiation of lymph nodes?*
Do you have any site restrictions due to: incisions, open wounds, drains, dressings, skin sensitivities, rash/skin conditions, IV, port, ostomy, catheter or other device?*
Do you have any pressure restrictions due to (check ALL that apply):*
Do you have any position restrictions due to (check ALL that apply):*
Are/did you experience peripheral neuropathy?*
Waiver of Liability and Consent to have Massage*
Cancellation Policy*
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