Massage And Bodywork Intake Form: Use ONLY For Relaxation And Body Scrubs

  • Wellness & Treatment Intake Form

    Required for your therapist to personalize your session.

  • New Client Information

  • Birthday*
     - -
  • Format: (000) 000-0000.
  • Gender*
  • Format: (000) 000-0000.
  • Are you using a gift card/gift certificate?
  • How would you like to provide your gift card details?
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  • MASSAGE INFORMATION

    • Click Here To Continue 
    • Please indicate the service(s) you are receiving today:*

    • Deep Relaxation Upgrade

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    •  

      Based on your current pain level, we strongly recommend enhancing your session with our Deep Relief CBD Infused Oil (+$45) to reduce inflammation, ease tension, and allow deeper, more effective muscle work.

      Prefer a lighter option? Our Deep Relief Aromatherapy Blend (+$20) helps calm the nervous system and enhance relaxation.

       

    • Selecting now ensures your therapist prepares your session for targeted results.

    • Based on your stress level, most clients with your pain level choose one of the following to get better results today:Deep Relief Aromatherapy Blend (+$20) to calm the nervous system and promote deeper relaxation.

    • Have you had a professional massage before?
    • Do you have any difficulty lying on your front, back, or side?
    • Do you have any allergies to oils, lotions, or ointments?
    • Do you have sensitive skin?
    • Do you have any chronic, ongoing pain that you deal with on a regular basis?
    • Any recent surgeries or injuries?
    • Are you currently pregnant?
    • What pressure do you prefer?
    • Which scent will you choose for your glow?

    • Enhance Your Results Today (Optional)

      Select any enhancements you'd like added to your session.

    • Most clients enhance their session for better results and deeper relief.

    • Based on your pain level, Medi-Cupping may help reduce muscle tightness, improve circulation, and support deeper relief during your session.

    • Pain & Recovery
    • Relaxation & Luxury
    • Add-On Treatments

    • Facial/Skincare Information

    • Have you had a facial treatment before?
    • Do you have any chronic skin problems or concerns?
    • If you shaver your face, what is your current shaving system?
    • If you shave your face do you experience irritation from shaving?
    • Have you ever had a chemical peels, laser, or microdermabrasion?
    • Do you use Retin-A, Renova, Adapalene, Hydroxyl Acid, or Retinol/Vitamin A derivative
    • Have you recently used any self-tanning lotions, Creams, or treatments?
    • Do you use SPF on your face?
    • Have you experienced Botox, Restylane, or collagen injections?
    • Have you used any acne medication?
    • Are you undergoing any hormone replacement therapy?
    • Are you taking any oral contraceptives?

    • Appointment Policy & Card Authorization

      Please review before signing. This protects your appointment time and confirms your agreement to our cancellation, no-show, and card-on-file policy.

    • Cancellation, No-Show & Card Authorization Policy

      All appointments require at least 24 hours’ advance notice to cancel or reschedule.

      I confirm I selected my service above and agree to the cancellation, no-show, and card authorization policy. I understand I may be charged up to 100% of the scheduled service cost for late cancellations, no-shows, or same-day reschedules.

      I understand that appointment time is reserved specifically for me, and late cancellations or no-shows prevent the business from offering that time to another client.

      I agree that cancellations or reschedule requests are only valid once confirmed by Somatic Massage Therapy & Spa by text, email, phone, app notification, or booking system record.

      I authorize Somatic Massage Therapy & Spa to charge my card on file for:

      • scheduled services
      • completed services
      • missed appointments
      • late cancellations
      • same-day reschedules
      • applicable fees

      I agree that the business’s booking records, timestamps, text messages, email confirmations, intake form, signed authorization, and appointment history may be used as proof of the appointment, policy agreement, cancellation status, and authorization to charge.

      This authorization applies to today’s appointment and future appointments booked with Somatic Massage Therapy & Spa unless revoked in writing before the cancellation period begins.

    • Submission Timestamp
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