Client Health Questionnaire
All information shared will remain confidential.
Email *
Name *
Age *
City *
Phone number *
Occupation *
What is your intention seeking bodywork? *
Have you received bodywork before? If so, how was your experience? *
Is there any emotional healing you would like to explore? *
Please check any that currently apply:
Are you currently taking any medication?
Are you allergic or sensitive to:
Primary goal(s): (Please check all that apply)
Anything else you feel pertinent to share that wasn’t asked?
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