Welcome to Southern Charm Massage! We are excited you are joining the family. Our goal is to provide top quality services at an unmatched value.  Make sure you check out our FAQ page, as it will give you information to make the most of your experience.


Please click the above link, print out the form, fill it out and bring it with you. Or if you have time, fill it out below and submit.

Name *
Address *
Date of Birth *
Date of Birth
Cell Phone *
Cell Phone
Home Phone
Home Phone
Have you ever experienced a professional massage/body work before? *
If yes to previous question, how recently *
Have you had or do you have any of the following? Check all that apply. *
The massage/ bodywork I receive is to provide relaxation and relief of muscular tension. I will let my massage therapist know if the pressure given needs to be adjusted to my comfort level. The massage/ bodywork should NOT be a substitute for a medical exam, diagnosis or treatment. I understand that the massage therapist is not qualified to perform spinal adjustment, diagnosis, prescribe or treat any physical or mental illness. I agree to keep the massage therapist updated with any medical changes and understand that there is no liability on the practitioners part should I forget to do so. By submitting this form I agree and understand all the statements made here in and that all the information submitted is accurate. Any discrepancies may cause the therapist to cancel my appointment.