Full Name
*
First Name
Last Name
Preferred Pronouns
*
He/Him
She/Her
D.O.B
*
00/00/0000
Today’s Date
*
format:00/00/0000
E-mail
*
Your provided email will be the main point of contact for your appointment process moving forward. Please ensure your email is accurate, active, and regularly checked for important booking updates and session information.
Phone Number
*
I opt in and consent to updated information with Maximental Massage
Format: (000) 000-0000.
Preferred Method of Communication
*
Mobile Number
Email
Both
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you pregnant?
*
Yes
No
Are you High Risk or Low Risk.
High
Low
Select which trimester are you In?
First trimester: Weeks 1–12
Second trimester: Weeks 13–26
Third trimester: Weeks 27–birth (around 40 weeks total)
Which service are you interested in booking?
*
The Maximental [Relaxation]
The Maximountain [Deep Tissue]
The Maximuscle [Sports Massage]
The MaxiSole [Foot Massage]
30 MIN CHAIR MASSAGE
Have you ever received a massage before?
*
Yes
No
Are you booking for yourself or someone else?
Preferred Session Length
*
15 MIN
30 MIN
60 MIN
90 MIN
Preferred Appointment Date & Time
*
Are you booking your session with a package deal voucher code ? If yes please insert below.
Would you like to include Add-Ons In your service.
Hot Stones
+ 30 MIN
Don’t see your desired session date? Please select below.
Don’t see your desired session Time ? Please list below.
Massage Preferences
Our services are tailored to be intentional and uniquely curated for you.
Any Focus areas ?
*
Sensory & Comfort Preferences
Preferred Massage Pressure
*
Light
Medium
Firm
How did you hear about us?
Instagram
Facebook
Family or Friend if so please list below
Consent & Signature
your consent matters.
I understand that massage therapy is for the purpose of stress reduction, relief from muscular tension or spasm, or for increasing circulation. I understand that the massage therapist does not diagnose illness, disease or any other physical or mental disorder. The massage therapist does not prescribe medical treatment nor perfom spinal manipulations. I will inform the therapist of my current condition at the time of each visit.
Type , “ I understand”
I consent to receiving a massage on scheduled date upon booking.
“I consent “
“I do not consent”
Notes:
please note any additional information you would like me to know.
Please Print your name below ,confirming you have read all booking/cancellation policies.
Consent & Signature
I understand that massage therapy is for the purpose of stress reduction, relief from muscular tension or spasm, or for increasing circulation. I understand that the massage therapist does not diagnose illness, disease or any other physical or mental disorder. The massage therapist does not prescribe medical treatment nor perfom spinal manipulations. I will inform the therapist of my current condition at the time of each visit.
type “ I understand”
I consent to receiving a massage on scheduled date upon booking.
I consent
I do not sent
Submit
Time
*
AM
PM
AM/PM Option
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