Massage Intake Form

Name *
Name
Birthdate *
Birthdate
For example: tight hip, lower back pain, relaxation, etc.
Was there an activity that caused it? Does it hurt when you move/sit still for long periods?
Have you had bodywork in the past? *
Deep tissue, rolfing, swedish, myofascial release, trigger point, etc.
What level of pressure do you prefer? *
Would you like to conclude your massage with Energy Work?
$15 add on for twenty minutes