Valentine's Day Gift Certificates

Treat everyone you love this Valentine's Day: Buy one gift certificate, get one at half price!

Gift certificates are available in any dollar amount, and expire one year from date of purchase. You can even use them for yourself! Gift Certificates are printed on high quality stock, and come in a beautiful linen gift envelope.

If your intended recipient is a new client, then a gift certificate for just $45 will give them a one hour massage! Get a second $45 gift certificate for just $22.50 and use it yourself, or give it to your mother, sister, or anyone else you care about.

Give everyone you love the chance to relax or get rid of pain for Valentine's Day!

Prenatal Massage (For Free!)

I am working on expanding my skills by completing continuing education in prenatal (pregnancy) and postpartum massage therapy. In order to complete my certification, I need to provide practice massage sessions.

I am offering these one hour massage sessions for free. However, I only need a limited number to complete my training, so this is first to book an appointment, first served!

You must be currently pregnant or have given birth within the last month. You must be having a low-risk pregnancy with no complications, or have a doctor's note stating that it is safe for you to receive massage. All sessions will be performed at my office in Titusville.

Prenatal massage has incredible benefits for expectant mothers! It helps to relieve the aches and pains as your body changes and increases relaxation. If you have any questions, don't hesitate to ask.

Call or email to book!

Informed Consent

Informed Consent

1: Payment and Confidentiality

It is my commitment to be on time for our sessions and maintain your privacy and confidentiality. I will maintain a professional, clean space that is safe physically and psychologically. I will be present in our sessions and give you my full attention and best work. In return, I expect you to also make every effort to arrive on time, clean, and ready for our sessions. Payment is due at the time of the session in cash or check. The fee for returned checks is $20. If you need to cancel a session, I ask that you give 24 hour notice or I will expect payment for the session.

It is my professional duty to maintain your privacy and confidentiality. Some conditions may require my communication with your doctor or other professionals, but I will ALWAYS seek your written consent before disclosing any information about our work to other parties.

2: Purpose of Massage

Massage and bodywork can help relax a person and relieve stress. It can help rehabilitate after an injury or surgery, or help with pain, arthritis, and many other conditions. Therapeutic massage can improve quality of life and the function of the body, and prevent injury or pain in the future, However, none of these results are guaranteed. If you feel that you are not getting as much benefit from our work as you would like, please let me know and we can try another approach. Every therapist and every client are different- you may respond differently than others.

Please understand that my work is therapeutic, designed to enhance your life and help you achieve wellness- it can be very enjoyable, but it is NOT sexual.

3: Other information

Most people disrobe fully for therapeutic massage sessions, but please only remove what you are comfortable with. You will be draped at all times, except in the immediate area I am working on. If you feel pain, or discomfort, please let me know, as my goal is for you to benefit from my work.

If you have any questions about therapeutic massage or any aspect of my work, please ask! You will see greater benefit from our work the more you are involved!

I, _______________________________ have read and understood this information and agree to receive therapeutic massage from Jen Kobrick, LMT

X__________________________________________________ Date: _____________

Health History

HEALTH HISTORY - LIFESTYLE INTAKE
All information disclosed in this health history will remain confidential. 
Use the back if you need space.
Name: ____________________________ Date: ___/___/______ Birth date: ___/___/______
Phone: _____________________ Email: ______________________________________
Would you like to receive monthly emails with news and discounts? Yes_______ No _______
Address: Street: _______________________ City: ____________State: _____ Zip: ________
Emergency Contact: Name: _________________________ Phone: _____________________
How did you hear about me? _____________________ Referred by: _____________________
Please list any allergies or sensitivities, especially to oils, lotions, or scents, and latex:
___________________________________________________________________________________
Current Medications (Prescription and over the counter, including dose, reason for taking, and side effects):
___________________________________________________________________________________
___________________________________________________________________________________
Do you have any ongoing or frequent pain, tension or other discomfort or dysfunction? _______________
If yes, where? _______________________________________________________________________
How often does it occur? _______________________ How severe is it? __________________________
What makes it better? _________________________________________________________________
What makes it worse? _________________________________________________________________
Women: Are you pregnant? ________ Due Date: ________ Complications? _______________________
Do you consider yourself stressed? ________________ What causes your stress? ___________________
___________________________________________________________________________________
Where in your body to you store or carry stress? _____________________________________________
Are you working with other physical or mental health professionals on a regular basis?
__________________________________________________________________________________
Please check any that apply
o Headaches                  o Vision problems               o Sinus problems                o Jaw pain/teeth grinding
o Fatigue                        o Depression                        o Sleep problems                o Numbness/tingling
o Blood clots                 o Scoliosis                            o Arthritis                            o Tendonitis
o Lymph conditions     o Osteoporosis                    o Varicose veins                 o High/low blood pressure
o Muscle/joint pain      o Diabetes                            o Cancer/tumors                 o Infectious disease
o HIV/AIDS
List any major illnesses, hospitalizations, surgeries, etc, with dates. Please include car accidents.
___________________________________________________________________________________
___________________________________________________________________________________
Have you healed fully from these? _______________________________________________________
What kind and frequency of exercise do you do? Do you participate in any sports?
___________________________________________________________________________________
___________________________________________________________________________________
What is your occupation? ______________________________________________________________
Please circle all of these that you do for your job:
Standing – Sitting Still – Hold a Phone – Drive – Use a Computer – Perform Repetitive Motions
Have you received massage therapy or bodywork before? ______What types? ______________________
How often? ______________________ When was your last session? ____________________________
Is there any part of your body you would like me to avoid working on? ____________________________
Is there anything else I should know before we begin?
__________________________________________________________________________________
This health history is complete to the best of my knowledge. I understand that my massage therapist 
cannot take into account any conditions I do not inform her of.
Signature: ______________________________________________ Date: __________