{"id":271191,"date":"2024-04-11T13:52:13","date_gmt":"2024-04-11T13:52:13","guid":{"rendered":"https:\/\/lavidamassagetampafl.com\/?page_id=271191"},"modified":"2024-04-11T13:52:13","modified_gmt":"2024-04-11T13:52:13","slug":"returning-guest-intake-form","status":"publish","type":"page","link":"https:\/\/lavidamassagetampafl.com\/forms\/returning-guest-intake-form\/","title":{"rendered":"Returning Guest Intake Form"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_8' style='display:none'><div id='gf_8' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_8' id='gform_8'  action='\/wp-json\/wp\/v2\/pages\/271191#gf_8' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_8_1\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_1\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_1'>\n                            \n                            <span id='input_8_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_8_1_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_8_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_8_1_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_8_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_3\" ><label class='gfield_label gform-field-label' for='input_8_3'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_8_3' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_5\" ><legend class='gfield_label gform-field-label' >Any changes to medical condtions:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_5'>\n\t\t\t<div class='gchoice gchoice_8_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='No'  id='choice_8_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_5_0' id='label_8_5_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Yes'  id='choice_8_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_5_1' id='label_8_5_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_6\" ><label class='gfield_label gform-field-label' for='input_8_6'>If yes, please give detail<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_8_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_7\" ><legend class='gfield_label gform-field-label' >Any changes to allergies:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_7'>\n\t\t\t<div class='gchoice gchoice_8_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_8_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_0' id='label_8_7_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_8_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_1' id='label_8_7_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_8\" ><label class='gfield_label gform-field-label' for='input_8_8'>If yes, please give detail<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_8_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_9\" ><legend class='gfield_label gform-field-label' >Any recent surgeries or injuries (last 2 year):<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_9'>\n\t\t\t<div class='gchoice gchoice_8_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_8_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_0' id='label_8_9_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_8_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_1' id='label_8_9_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_10\" ><label class='gfield_label gform-field-label' for='input_8_10'>If yes, please give detail<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_8_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_14\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" data-js-reload=\"field_8_14\" ><label class='gfield_label gform-field-label' >Tell us about your current stress level<\/label><div class='ginput_container ginput_container_likert'><table aria-label='Tell us about your current stress level' class='gsurvey-likert' id='input_8_14'><thead><tr><th id='likert_col_1_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>Completely Relaxed - 0<\/th><th id='likert_col_2_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_8_14' scope='col' role='presentation' class='gsurvey-likert-choice-label'>Very Stressed - 10<\/th><\/tr><\/thead><tbody><tr><td data-label='Completely Relaxed - 0' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14367e3a83'  id='choice_8_14_1'    aria-labelledby='likert_col_1_8_14'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14a1c7df1e'  id='choice_8_14_2'    aria-labelledby='likert_col_2_8_14'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14c10d7081'  id='choice_8_14_3'    aria-labelledby='likert_col_3_8_14'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14433769ce'  id='choice_8_14_4'    aria-labelledby='likert_col_4_8_14'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol146fe9e0bb'  id='choice_8_14_5'    aria-labelledby='likert_col_5_8_14'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14db941a74'  id='choice_8_14_6'    aria-labelledby='likert_col_6_8_14'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol1457926f1e'  id='choice_8_14_7'    aria-labelledby='likert_col_7_8_14'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol1479222bf1'  id='choice_8_14_8'    aria-labelledby='likert_col_8_8_14'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol147c664352'  id='choice_8_14_9'    aria-labelledby='likert_col_9_8_14'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol149cf9bf09'  id='choice_8_14_11'    aria-labelledby='likert_col_11_8_14'\/><\/td><td data-label='Very Stressed - 10' class='gsurvey-likert-choice'><input name='input_14' type='radio' value='glikertcol14bc20e27d'  id='choice_8_14_12'    aria-labelledby='likert_col_12_8_14'\/><\/td><\/tr><\/tbody><\/table><\/div><\/div><div id=\"field_8_15\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" data-js-reload=\"field_8_15\" ><label class='gfield_label gform-field-label' >Tell us about your current pain level<\/label><div class='ginput_container ginput_container_likert'><table aria-label='Tell us about your current pain level' class='gsurvey-likert' id='input_8_15'><thead><tr><th id='likert_col_1_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>Pain Free - 0<\/th><th id='likert_col_2_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_8_15' scope='col' role='presentation' class='gsurvey-likert-choice-label'>Extreme Pain - 10<\/th><\/tr><\/thead><tbody><tr><td data-label='Pain Free - 0' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14367e3a83'  id='choice_8_15_1'    aria-labelledby='likert_col_1_8_15'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14a1c7df1e'  id='choice_8_15_2'    aria-labelledby='likert_col_2_8_15'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14c10d7081'  id='choice_8_15_3'    aria-labelledby='likert_col_3_8_15'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14433769ce'  id='choice_8_15_4'    aria-labelledby='likert_col_4_8_15'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol146fe9e0bb'  id='choice_8_15_5'    aria-labelledby='likert_col_5_8_15'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14db941a74'  id='choice_8_15_6'    aria-labelledby='likert_col_6_8_15'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol1457926f1e'  id='choice_8_15_7'    aria-labelledby='likert_col_7_8_15'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol1479222bf1'  id='choice_8_15_8'    aria-labelledby='likert_col_8_8_15'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol147c664352'  id='choice_8_15_9'    aria-labelledby='likert_col_9_8_15'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol149cf9bf09'  id='choice_8_15_11'    aria-labelledby='likert_col_11_8_15'\/><\/td><td data-label='Extreme Pain - 10' class='gsurvey-likert-choice'><input name='input_15' type='radio' value='glikertcol14bc20e27d'  id='choice_8_15_12'    aria-labelledby='likert_col_12_8_15'\/><\/td><\/tr><\/tbody><\/table><\/div><\/div><fieldset id=\"field_8_19\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_19\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_19.1' id='input_8_19_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_8_19\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_19_1' >I affirm that I have read the important notice below before signing this document.<\/label><input type='hidden' name='input_19.2' value='I affirm that I have read the important notice below before signing this document.' class='gform_hidden' \/><input type='hidden' name='input_19.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_8_19'>If you have certain medical conditions or symptoms, receiving a massage may aggravate or worsen that condition. If you are experiencing a cold, fl u, fever, or have consumed alcohol in the past 12 hours, your session must be rescheduled for 48 hours after symptoms disappear. By signing below, I am stating that I understand there are benefits and risks of massage therapy. I understand that massage is not a replacement for medical care, or medical examination. I acknowledge that any recommendation made by my massage therapist is not considered a medical diagnosis, or advice and that there is no stated promise of success of techniques, or services. I have listed all medical conditions (including past conditions, such as operations) that I am aware of and this information is true and accurate to the best of my knowledge. Before beginning a future session, I agree to inform the massage therapist immediately of any change in my health. I acknowledge that this information is confidential and intended for review by massage therapists, that a medical referral may be requested of me, and that LaVida Massage is not liable for the management of any condition whether it is identified or not on this form. This center location is independently owned.<br \/>\n<br \/>\nI agree to inform my massage therapist of any discomfort or pain experienced during the session so any adjustments can be made to the pressure, draping or <br \/>\nenvironment. LaVida Massage is not liable for any injury or condition that arises from the application of massage, despite the completion of this form. This form is only intended as an assessment tool and serves as a guide for the application of massage. All services include 5 minutes for pre-consultation and un-dressing and 5 minutes for post-consultation and re-dressing. 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