Massage Client Information

Please be sure to fill out this form as completely and accurately as possible so that we can provide you with the best possible experience. For more information on the products and services we offer, please contact us, we'll be happy to answer any questions you may have.

General Information

First Name:

Last Name:

Age:

Address:

City:

State / Province:

Zip / Postal Code:

Phone #:

Emergency Phone #:

Referred By:

Your Occupation:

Prior Experiences

Have you ever received professional massage/bodywork before?

If Yes, How Recently?

About Your Session

What types of massage/bodywork do you prefer?

What kind of pressure do you prefer?

What are your goals/expected outcomes for receiving massage/bodywork?

How do you feel today?

Are you wearing a hairpiece?

Security Questions

If you're not a robot, what is 400 + 26?