Barefoot Vibes: KaHuna Massage

Barefoot Vibes: KaHuna Massage

New Client Form
Thank you for your interest in booking a KaHuna Massage with Sasha Hopkins Mobile Service within Moreton Bay Ph 0403 580 790

Please complete this form and list your preferred days and times of the week. Sasha will be in touch within 48hrs with availability.

Please know that Sasha treats each client as an individual and understands that everyone's needs are different. All information provided is strictly confidential between Sasha (the practitioner) and you (the client). If any of the questions are unclear or you would prefer not to answer, you may choose to leave them blank.

KaHuna Massage Fees:

60min ~ $140
90min ~ $180
120min ~ $220
Preferred day/s of the week*

MondayTuesdayWednesdayFridaySaturday
Preferred times in the day*

8am-12pm12pm-3pm3pm-6pm
Massage Length*

60min ~ $14090min ~ $180120min ~ $220
Additional information for booking request
Name*
Date of Birth

MonthDayYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile*
Emergency Contact Name*
Phone*
Referred by? How did you find me?
Do you have any allergies or sensitivities that I need to be aware of? If Yes, please provide details
Are you taking any medication(s) that I need to be aware of? If Yes, please provide details
Have you had or are you currently experiencing any of the following?

MigrainesDiabetesHypoglycaemiaRecent surgical proceduresEpilepsyPhobiasSensory sensitivitiesHigh/low blood pressureBreakdownsInsomnia*Other
*Other (please specify
Are you Pregnant? If Yes how many weeks? Or have you given birth in the last 12 weeks?
KaHuna Massage is offered on a massage table do you have any mobility restrictions that I need to be aware of and/or do you need extra support?
Have you received a KaHuna Massage before? If so how was this experience for you?
I acknowledge that KaHuna massage involves draping and is required by law.*

Yes, I acknowledge this
I acknowledge that KaHuna massage is not a sexual massage.*

Yes, I acknowledge this
To the best of my knowledge, all the above information is true and correct.*

Yes
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