Questionnaire

Name *

First

Last

Phone *

Email *

Is this your first time with us?

How did you hear of us? *

How often do you get massages? *

If other how often?

Are you in pain? *

Describe the pain

Do you have any other conditions? *

Describe the condition

Are you taking any medications that may be harmful to getting a massage? *

What medication?

Have you had a positive COVID-19 test for active virus in the past 10 days, or are you awaiting results of a COVID-19 test? *

Can we send you a text message for special promotions *

Please comment if you have any other questions or concerns

Contact Info