BODY MAPPING

BODY MAPPING

Digital Consultation Form
Welcome to The Ritual Co. Tribe! We can’t wait to meet you.

New guests start working with us by completing a digital consultation form. This allows us to get to know you and your body goals so that we can ensure your initial appointment is booked properly.

Please complete the form in full and we'll be in touch within 24 working hours of your request, Monday-Saturday. All requests submitted Saturday will be responded to on Monday.

If you have any questions or need support please email us at contact@theritualcompany.com
ABOUT YOU
What is your full name? *

First Name Last Name
Pronoun
What is your email address? *
Please note, I will be reaching out by email to confirm your appointment
Phone Number *
Please note, I will respond by text to confirm your appointment
How should we contact you?

text email
What is your mailing address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Age *

under 21 21-30 31-40 41-50 51-60 60 +
What is your Instagram Handle?
How did you hear about us? *
Tell us more about how you found us *
What is the name of the client who referred you to my business? *
What body therapist are you looking to book your appointment with? *
What is your budget for this requested appointment?
This will help us determine what therapist and services to book you with
What days/times are you available? We will make every effort to get you in as soon as possible in line with the information you enter here. The more available you are, the faster we will be able to get you in. *

Weekdays 9am-12pm Weekdays 12pm-4pm Weeknights 4pm-7pm Weekends 9am-12pm Weekends 12pm-4pm I will make anything work, I just need to get in ASAP I have a specific date and time in mind
Date

Month Day Year
Date
Time

Hour Minutes

AM/PM Option
Please select the categories that you would like to focus on at your first visit.

massage sculpting
YOUR HEALTH
Within the last year, have you had any health problems that we should be aware of? *

yes no
Please specify *
Have you recently undergone any surgery? *

yes no
Please specify type and date. *
List any medications, supplements, vitamins, diuretics, slimming pills, oral contraceptives, Isotretinoin, etc. that you take regularly.
Please specify if any of the following apply to you.

pregnant trying to become pregnant lactating
How far along are you? *
IN MONTHS
Are there any high risk factors?
TYPE NO IF NONE
Have you had any orthopedic injuries? *

yes no
Please specify. *
Do you personally have a history of any of the following?

cancer headaches/migraines diabetes join replacement high/low blood pressure neuropathy fibromyalgia stroke heart attack kidney dysfunction blood clots numbness epilepsy sprains or strains
Have you undergone chemotherapy in the last 6 months? *

yes no
Please explain any condition that you have marked.
Please select all that currently apply to you?

blood thinning medication open wounds/sores/thinning skin peripheral vascular disease inflammatory skin conditions autoimmune condition ( MS, Lupas, RA ) varicose veins edema or lymphodema heat sensitivity under the use of drugs or alcohol NONE
Please explain any condition that you have marked.
Do you have metal implants, a pacemaker or body piercings? *

yes no
Do you have any allergies? *

yes no
Please specify *
Do you have sinus problems? *

yes no
Have you ever experienced claustrophobia? *

yes no
What were the circumstances? *
Do you bruise easily? *

yes no
Do you suffer with chronic pain? *

yes no
What makes it better?
What makes it worse?
Do you exercise regularly? *

yes no
How often? *
What type? *
BODY MASSAGE GOALS
Have you had a professional massage before? *

yes no
When was your last massage?
What pressure do you typically prefer? *

light medium firm not sure
What goal are you seeking with this massage? *

Relaxation Theraputic / Deep Tissue Lymphatic / Post-Op Recovery
If post-op, please specify what surgery. *
Please select the areas that you are currently experiencing discomfort? *

scalp face neck shoulders chest arms hands abdomen upper back lower back glutes upper legs lower legs feet NONE
Please explain. *
Are there any areas that you would like us to AVOID? Your massage therapist will ALWAYS AVOID working within several inches of the genital area.

scalp face neck shoulders chest arms hands abdomen upper back lower back glutes upper legs lower legs feet NONE
Would you like to elaborate?
BODY SCULPTING GOALS
Please choose the area of concern that applies for each of the body sculping goals that you would like to address at your first visit.
SKIN TIGHTENING

abdomen arms upper legs "saddle bags" upper thigh/hamstring calf flanks "love handles" lower back upper back
INCH LOSS

abdomen arms upper legs "saddle bags" upper thigh/hamstring calf flanks "love handles" lower back upper back
CELLULITE REDUCTION

abdomen arms upper legs "saddle bags" upper thigh/hamstring calf flanks "love handles" lower back upper back
PLUMPING/LIFTING

hips lower buttock upper buttocks
Is there anything else you think we should know ?
This consultation card is used to evaluate your individual body care needs. We will maintain the confidentiality of this information, and will disclose this information only: (i) to our staff members, (ii) to quality assurance and quality control personnel, (iii) to our product supplier and manufacturer. We will not provide this information to anyone else, except as required by law, and we will not sell this information to anyone. We may, however, contact you with product-related information.
By completing this form, I am submitting an appointment request and price quote inquiry. In response, I will receive an email/text with an appointment time and date option, general price quote and instructions to move forward.

Generally, new guests are able to be seen within 2-3 weeks of appointment submission request, but guests with limited availability may have to wait up to 12 weeks to be seen.
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BODY MAPPING

ABOUT YOU

YOUR HEALTH

BODY MASSAGE GOALS

BODY SCULPTING GOALS