Massage & Hot Stone Therapy Form

Massage & Hot Stone Therapy form

Full Name

Phone Number

Email Address

Phone

Text Message

Preferred Date

Preferred Time

Service Requested

Session Length

Other (please specify)

Have you had a massage before?

Yes

Do you have any injuries, medical conditions, or allergies we should know about?

Have you ever had a negative or uncomfortable experience during a massage?

Yes

If yes, please tell us about your experience and any concerns you'd like us to be aware of:

Are you currently pregnant?

Yes

Areas you'd like us to focus on:

Other Focus ?

Preferred Massage Pressure

Light

Medium

Firm

Additional Requests

I understand that massage therapy is for relaxation and wellness purposes and is not a substitute for medical treatment.

I confirm that the health information I have provided is accurate.