Client Intake Form

The information collected in this form will be used only for the purpose of designing an appropriate massage therapy program for you and will not be disclosed to any third party without your consent.

General Information

In case of emergency, please notify:


Massage Information


Medical Information


eg. lower back, upper torso

Questions? Talk to us!

We're not around right now. But you can send us an email and we'll get back to you, asap.

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