To help us better serve you, please fill out this form prior to your scheduled appointment time.

Name:*
Appointment Date:*
E-mail:*
Phone:
-
Address:
Subscribe to Newsletter:*
Verify:
Have you had a massage before?
Are you pregnant:
Do you have sensitive skin?
Pressure Preferred:
Are you allergic to any essential oils? *
Current Medications:*
List any surgeries, injuries, or illnesses (date & type)*
List any areas where you're experiencing tension, stiffness, pain or discomfort:
What are your goals with this appointment?
Emergency Contact Phone:*
-
Emergency Contact:
Comments:
massage