Manual Lymphatic Drainage Therapy Intake
This intake form is for those seeking manual lymphatic drainage therapy that is not related to a diagnosis or history of cancer. If you are seeking general therapeutic massage or lymphatic drainage therapy related to any form of cancer diagnosis or treatment please complete the appropriate intake form at
Please share your basic contact information and contact preferences so that I know the best way to stay in touch.
Date of Birth
Preferred Contact Method
Would you like to receive a weekly email offering open sessions when available?
Would you like to receive an occasional newsletter with information and resources?
How did you hear about me?
Through Creative Wellness
Through a friend
If you were referred to me are you willing to let me thank the person? If so please share their name.
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This form was created inside of Amy Hartl, Licensed Massage Therapist.
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