We Love Our Clients!!!

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

First Name *
Last Name *
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Date of Birth *
Phone # *
Email *
Occupation *
Who can we thank for this referral?

Have you experienced a professional massage / body work before?

 *

If yes to previous question, how recently?

Did you experience any pain or bruising during or after your massage? If, yes, please explain. If No, type N/A, etc. *

Have you had or do you have any of the following? Check all that apply. 

 *
Are you pregnant? If so how far along re you? If No, type N/A, etc. *
Any accidents, injuries, or surgeries in the past 2 years? If yes, please describe. If No, type N/A, etc. *
Any medical conditions, chronic or acute, that your therapist should be aware of? If yes, please elaborate. If No, type N/A, etc. *
"Very talented and knowledgeable massage therapist. I always feel revitalized, recharged after my treatments."  ~ Pam H.