Intake Form
Required for all new clients
Basic Information
Full Name
*
First Name
Last Name
What is your age?
*
Must be 18+
What is your gender?
*
Please Select
Male
Female
N/A
Contact Number
Email Address
*
example@example.com
Have you received professional massage or bodywork before?
Please Select
Yes
No
Comfort & Preferences
Are there any areas you prefer not to be touched?
Yes
No
Please list them.
Are there any areas you would like more focus on?
Yes
No
Please list them.
How would you describe your comfort level with intimate touch?
*
Low
Medium
High
What are you hoping to get out of our session together?
*
Boundaries & Communication
I understand that I may communicate discomfort or request changes at any time, and that my boundaries will be respected at all times.
*
Yes
No
Donation & Terms Acknowledgement
I understand that any donation is given in exchange for Bryan's time, training, and professional bodywork services only.
*
Yes
No
I understand that no explicit sexual services are offered.
*
Yes
No
ID Verification
Used to verify authenticity, images and links are deleted immediately, never stored
Please upload an image of yourself. Unedited selfies preferred.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Send a link to your social media / LinkedIn
For ID verification purposes only
Confidentiality
I understand that services are completely confidential. My identity and Bryan's identity are confidential and discrete at all times.
*
Yes
No
Submit
Should be Empty: