Short Intake - Bodywork Session

1

What's your full name?* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone NumberFor easier communication. You can leave this blank if you prefer to be contacted by email.

Area Code

Phone Number

4

Instagram handleThis helps me recognise you and gently prepare for your session 🤍

5

This work is currently offered exclusively to women.* This field is required.Please confirm before continuing.

I confirm that I am a woman and would like to proceed.I am not a woman.

6

What is bringing you to seek bodywork at this time?* This field is required.Are you experiencing stress, tension, overwhelm, emotional heaviness or simply seeking deep rest?

7

What kind of experience are you hoping for?* This field is required.select all that apply

Deep rest and relaxation

Stress release & Nervous system calming

Gentle tension release in the body

Support releasing deeper tension or emotional holding

I'm not sure, I'd love guidance

8

My sessions are slow, calm and often quiet, and may include gentle breath guidance and grounding touch. Does this feel comfortable and aligned for you?* This field is required.

Yes

Unsure

No

9

Before your session, is there anything you're currently feeling in your body that you'd like me to know about or focus on?* This field is required.for example: neck tension, jaw tightness, lower back pain, emotional stress, overwhelm, fatigue, difficulty relaxing etc...

10

Are you currently experiencing any acute injuries, severe pain, or conditions requiring medical treatment?

No

Yes

11

If yes please briefly explain

12

Choose your session* This field is required.All sessions begin with grounding and breathwork to help settle the nervous system.

Nervous System Reset Massage - £60 (90minutes)

Myofascial Release Bodywork - £60 (60minutes)

The Sacred Reset - £95 (120minutes signature treatment)

Not sure yet - I'd love some guidance

13

Please share your general availability.* This field is required.best suited times & days for when your available for the treatment

14

How did you hear about my work?* This field is required.

Instagram

TikTok

Word of mouth

Poster /flyer

15

Consent & Agreement * This field is required.- I understand that Sasha's work supports relaxation, nervous system regulation, and general wellbeing. - I acknowledge that this bodywork is not a substitute for medical diagnosis or treatment, and that Sasha does not diagnose medical conditions. - I confirm that the information I have provided is accurate to the best of my knowledge and that I will inform Sasha of any changes to my health before the session.

I understand and consent to receive bodyworkNo