New Client Intake Form
Do these symptoms interfere with your daily living activities? ( e.g., sleep, exercise, work, childcare)?
How would you rate your overall health?
List current medications and the conditions they're treating*
Are you wearing contacts?
Are you wearing dentures?
Have you ever received professional massage/bodywork before?
What kind of pressure do you prefer?
Is this massage/bodywork medically necessary (is it for a medical condition, injury, surgery)?
Please check areas you give consent to have worked during your bodywork session:
Musculoskeletal System: *