Name *

First Name

Last Name

Phone

(###)

###

####

Are you pregnant or do you have any pregnancy-related conditions? *

Only if you've answered "No", you may proceed filling out the form.

Yes

No

Recovering from recent pregnancy

What modality are you interested in? *

Myofascial Release

Neuromuscular/Trigger Point Therapy

Sports/Stretch Facilitation

Swedish

Cupping

Gua Sha

Deep Tissue Massage

KT Taping

Mobility Coaching

Session Duration *

90 minutes

2 hours

CONSENT & AGREEMENT *

I agree to receive massage therapy or stretching services and confirm that the health information I’ve provided is accurate to the best of my knowledge. I understand that my therapist will adjust techniques based on my comfort level and any conditions I disclose.

I understand that cancellations must be made at least 24 hours in advance to avoid being charged a cancellation fee.

How did you hear about us? *

Word of Mouth

Online Search