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New Client Intake Form

Welcome to our online Client Intake Form

This information will be sent directly to our clinic and will help us to better serve your healthcare needs. All your information is kept discreetly and securely.

Please fill out this form, and press the SUBMIT button at the end.


  • Your email will NOT be shared with any third parties.
    I understand that massage is not a replacement for medical care and that no medical diagnosis will be made. Because massage and bodywork therapy may be contraindicated due to certain medical conditions, I affirm that I have informed the therapist of all known medical conditions and will keep the therapist updated as to any changes in my medical condition going forward. If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or manipulation, draping or environment may be adjusted to my level of comfort.
    I agree to give 24 hours advance notice of scheduled session, or to assume responsibility for payment of the full fee.