Intake form

Help us serve you better

Name *

Email address *

Phone number

Preferred date and time for the appointment

Type of massage desired

Please select at least one option.

Swedish

Deep Tissue

Prenatal

Geriatric

Senior Massage

Myofascial Release

Lymphatic Drainage

Any specific areas of concern

Have you had any recent injuries or surgeries?

Are you currently taking any medications?

How did you hear about us?

Additional questions or comments

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Massage Co.