Schedule a Session -

Ready to Schedule Your Session?

Please complete the Client Intake Form below to schedule your appointment. This helps me better understand your needs and prepare for our time together. Thank you for your trust. It is an honor to be part of your wellness journey, and I look forward to connecting with you soon! If you have any questions, please contact me!

Client Intake Form

Name

First

Last

Preferred Name

Date of Birth

Phone

Email Address

Occupation

Emergency Contact

Reason for Session

Body Feeling

Anything Else?

pain, Else for

Anything Else - Emotional/Energetic

Areas of pain, tension, or restriction

Acknowledgment

I understand that bodywork is intended to support relaxation, reduce stress, relieve muscular tension, and promote overall well-being. It is not a substitute for medical diagnosis or treatment.

I understand it is my responsibility to inform my practitioner of any changes to my health, medications, or medical conditions before future sessions, and that I may communicate any discomfort or request changes to the session at any time.

I understand that bodywork is intended to support relaxation, reduce stress, relieve muscular tension, and promote overall well-being. It is not a substitute for medical diagnosis or treatment.

Client Signature

Clear Signature

Date

Thank you for trusting me with your care. I look forward to meeting you exactly where you are!