Talasaage Halal Wellness Intake & Booking
Women-only, modest, halal wellness sessions. Please complete the intake and book your session below.
CLIENT INFORMATION
Full Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Age
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Email
*
example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address (City, State, Zip)
*
Emergency Contact Name & Phone
*
GENERAL HEALTH INFORMATION
Do you have any medical conditions, injuries, or surgeries we should be aware of?
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Yes
No
If yes, please explain:
Are you currently pregnant or postpartum?
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Yes
No
If yes, how many weeks/months postpartum?
Are you currently under a doctor’s care?
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Yes
No
If yes, please explain:
Do you have any limitations in movement or areas of discomfort?
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Yes
No
If yes, please explain:
What are your wellness goals for our sessions? (e.g., improve flexibility, reduce tension, posture, relax, etc.)
AGREEMENT & CONSENT
I understand that Talasaage Halal Wellness provides general wellness services and is not a medical treatment.
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I understand and agree
I understand that these services are not a substitute for medical advice or treatment.
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I understand and agree
I agree to communicate openly and stop any movement if I feel pain or discomfort.
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I agree
I confirm that I am 18+ years old (or have parental/guardian consent if under 18).
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I confirm
Signature
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Date
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Month
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Day
Year
Date
WOMEN ONLY. MODEST. HALAL. A safe, supportive, and faith-centered space for women to stretch, heal, and bloom.
BOOK YOUR SESSION
Which service would you like to book?
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Guided Stretching (60 min)
Pilates (60 min)
Yoga Sessions (60 min)
Lymphatic Wellness Education (60 min)
Breathwork & Relaxation (45–60 min)
Select your preferred date and time
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Donation (minimum $15–20 per appointment). Your donation allows us to continue providing a safe, halal, and supportive space for women to heal and thrive. Suggested: $15, $17, $20. ONCE YOU CLICK “Submit & Book Session”, you will receive a text message for payment to secure your appointment.
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APPOINTMENT REMINDERS
• Wear comfortable, modest clothing.
• Arrive 5–10 minutes early.
• Hydrate before & after your session.
• Please cancel or reschedule at least 24 hours in advance.
• This is a women-only space.
Submit & Book Session
Submit & Book Session
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