Massage Therapy & Body Work

Pricing:

Fill out the below form, next schedule, and finally make payment!!

It’s just that easy!

Name

First Name

Last Name

Mobile Number

Home Address (where session will be held)

If someone other than yourself, who is receiving Body Work?

Are you currently pregnant?

If so, how many weeks? When is your Estimated due date? Any complications?

Session Length

List any injuries, surgeries, skin conditions, health conditions, medications, and supplements.

Please list areas of concern; where you would like areas of focus:

eg hips, lower back, shoulders, wrists, etc.

Do you experience anxiety, tension headaches, trouble sleeping?

If so, please describe.