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Supportive Fertility Massage Intake Form
Are you seeing a Fertility Specialist?
Have you experienced a professional therapeutic massage before?
Are you actively trying to conceive?
Do you currently have any areas of discomfort?
Any past injuries or surgeries?
Is your partner open to receiving therapeutic massage?

If actively trying to conceive, appointments need to be between menses and ovulation. Fertility Massage will not be performed upon ovulation through menstruation.

Are your cycles regular/predictable?
Do you know when you ovulate?
Are you tracking your ovulation?
Do you have pain while ovulating?
What do you think is inhibiting conception?

Because massage/bodywork should not be performed under certain medical conditions, please make sure you have stated all known medical conditions and answered all questions honestly.

Please note: Body Rhythms Massage does not treat or prescribe within the context of your massage therapy session. Also, going through the process of Fertility Massage does not guarantee a successfully conceived pregnancy and Body Rhythms Massage does not promote this modality as such. Fertility Massage is a supportive massage technique designed to enhance the conception process.

Thanks for submitting!

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