Client Intake Form Name * First Name Last Name Email * Emergency Contact (###) ### #### What service are you interested in? Swedish Massage Deep Tissue Sports Massage Prenatal Massage Hot Stone Massage Trigger Point Massage Preferred Date MM DD YYYY Areas to focus on Briefly describe the areas you would like us to focus on during your session. Ares to avoid * Briefly list any areas to avoid during your session. Medical Conditions * Check boxes that apply Arthritis Diabetes Chronic Pain Whiplash Heart Condition Scoliosis Thank you!
