Maximental Massage Booking

Personal Information
Full Name

First NameLast Name
Today’s Date
format:00/00/0000
Which service are you interested in booking?
Preferred Appointment Date & Time
Preferred Session Length
Preferred Pronouns
D.O.B
00/00/0000
Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
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 MassageFormat: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Communication
The Mind Behind the Muscle

Allow Zakiya, Your Therapist To Understand You Better.
Current Occupation
Select your Frequent Activities & Hobbies
Select Your Wellness Goals with Maximental Massage.
Have you ever received a massage before?
Are you booking for yourself or someone else?
How often do you receive massages?
Previous Bodywork Experiences
Describe the experience or modality of your last massage session.
Do you have any current self care practices?
ex: yoga,meditation,journaling etc..
Medical Check In

Allow Zakiya , To Ethically & Safely Prepare For Your Session.
Are you pregnant?
Height

Feet Inches
Are you High Risk or Low Risk.
Select which trimester are you In?
Any Allergies?
Any Recent Surgeries or Current Treatments?
Massage Preferences

Our services are tailored to be intentional and uniquely curated for you.
Preferred Massage Pressure
Any Focus areas ?
Elevate Your Experience, Would you like to include Any?
Are you booking your session with a package deal voucher code ? If yes please insert below.
How did you hear about us?
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.
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.
Time

AM/PM Option
Should be Empty:

Personal Information

The Mind Behind the Muscle

Medical Check In

Massage Preferences

Consent & Signature

Consent & Signature