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?
Are there any medications and conditions they're treating your practitioner needs to be aware of?*
Will you be wearing contacts during your session?
Will you be wearing dentures during your session?
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 click here to mark areas give consent to have worked during your bodywork session:
Musculoskeletal System: *