CLIENT INTAKE FORM
How did you hear about us? Through a referral, online search, Yelp or other?
What service(s)are you interested in? Consultation, body sculpting, massage therapy, teeth whitening or wellness products?
Do you have any chronic medical conditions? If so, please list them:
Do you have any allergies to latex, medications, herbal or natural supplements? If so, please list them:
Do you have any hearing aids or implanted medical devices (i.e. pacemaker)?
Do you have or have you had cancer within the last 12 months? If so, are you currently undergoing chemotherapy treatment?
Please check all that apply:
high blood pressure
history of infections
neck or back issues
Are you currently pregnant or nursing?
Choose Your Massage
Mark Areas Of Concern
Please verify that you are human
( X )
Non refundable $25 deposit required, goes toward balance
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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