New Client Intake Form


Please fill out this form and submit it below before your first appointment.

Name *
Name
Phone *
Phone
Address
Address
Are you under a physician's care? *
Have you had surgery in the last month? *
Are you taking any medications? *
Please list and the or conditions associated with the medications.
Have you ever had a professional massage? *
Please check off any of the following conditions that you are experiencing:
If you have received any other treatment for your condition, please check any that apply:

Non-disclosure and Confidentiality Agreement

Considerations and Guidelines

Massage is a form of bodywork that dates back more than 3000 years. It involves the manipulation of tissue through touch to promote a client’s wellbeing and health. The benefits of massage therapy include improved circulation, digestion, immunity flexibility, breathing posture and over all general health. The reduction of stress and anxiety, increased clarity, increased energy and a greater sense of mind-body connection have greatly been improved.