Intake Form Please fill out our intake form before your first appointment. Today's Date * MM DD YYYY How did you heard about me? Whats your goal by using my services? Your Session Details What is the time of your preferred session and services you'd like to book? (Check out the booking page to see my schedule based on the time and services you select) First and Last Name * First Name Last Name Date of Birth * What is your email address? * What is your phone number? * (###) ### #### How do you feel today from 0 to 10? * 0 being unhappy and 10 super happy! What is your marital status? * Do you have children? Have you had any past surgeries or operations? * Have you had any past accidents or trauma? * Are you currently taking any medications? * Are you currently taking any vitamins or supplements? * How is your sleep? * How are your eating habits? * How active are you? * Do you have a menstrual cycle? * Are you in menopause? If yes, how long and when did it begin? * Are you currently using birth control? * Have you seen any type of therapist before? * What areas should we focus on? Do you have any pain? * What pressure do you prefer? * Do you have any sensitive areas or zones? * Do you smoke cigarettes? If yes, how often? * Do you use THC? If yes, how often? * Do you drink alcohol? If yes, how often? * Thank you for filling out our intake form! Feel free to book your session if you haven’t already. If you have any question, please go to our contact page and either fill out the form or contact the phone number listed.
