Oncology Massage

Name *

First Name

Last Name

Phone

(###)

###

####

Are you experiencing any of the following that would affect the massage or pressure? Please check all that apply. *

History or Risk of Lymphedema

Area of Pain

Fragile/Sensitive Skin

Fatigue

Recent Surgery

Swelling

Hot Flashes

Fragile Bones

Infection or Fever

Risk of Easy Bruising

Anticoagulants

Do you have any positioning needs due to the following: *

Incision

Swelling

Medical Device

Tumor Site

Difficulty Breathing

Do you have any areas that I should be mindful of due to the following: *

Incision

Fracture History

Bone Metastasis

Wound

Radiation Site

Tumor Site

Drain

Medical Device

Neuropathy

Skin Sensitivity

Area of Infection

IV Catheter