Massage Intake & Booking Request

1

Have you booked with me before?* This field is required.

Yes, I am a returning client and you have been to my home.

No, this is my first time.

2

Please check this box to confirm that you are aware that Bliss Path Holistic is a mobile massage practice. This means that your session will take place in your home or place of residence. I do not have studio that you can come to at this time.* This field is required.

Yes, I understand that this massage will be taking place in my home.

3

What type of session are you booking?* This field is required.

Bliss Combo /Relaxation

Therapeutic / Deep Tissue

Holistic Healing Massage

Myo-Lymphatic.

4

Bliss Relaxation / Combo Massage — select length* This field is required.

60 min – $150

75 min – $188

90 min – $225

120 min – $300

5

Therapeutic / Deep Tissue Massage — select length* This field is required.

60 min – $175

75 min – $215

90 min – $250

120 min – $350

6

Holistic Healing Massage — select length* This field is required.

60 min – $160

75 min – $200

90 min – $240

120 min – $320

7

Myo-Lymphatic Massage — select length* This field is required.

60 min – $160

75 min – $200

90 min – $240

120 min – $320

8

Is there anything acute going on right now — physically, emotionally, or seasonally — that's prompting this booking? (ex: migraine, injury, life change, etc.)* This field is required.

9

Any scent or product sensitivities / allergies?* This field is required.

Yes. We will review these in person before your session.

No.

10

Any medical condition, injury, or medication that may affect your session?* This field is required.

Yes — we'll review this together briefly before your session begins.

No.

11

How did you hear about this practice?* This field is required.

Google

Instagram / Facebook

Word of mouth / referral

Yelp

12

Would you like to receive my weekly newsletter that explores the body-mind connection, nervous system regulation, and inner journey reflections.* This field is required.

Yes, add me to your email list.

No, thank you.

13

I understand this is a licensed, professional, therapeutic massage practice — sessions are non-sexual and strictly therapeutic.* This field is required.

I agree