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Treatment Plan Assessment
These questions help identify your treatment goals and the best course of action to get the most from your massage treatment sessions.
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone number
Your answer
Best way to contact you
text
email
both
What are your treatment goals?
relax
reduce pain from nagging muscle soreness
improve joint mobility
reduce muscle spasms and trigger points from existing injury
improve quality of life
How often do you currently get a massage? Has massage helped you in the past?
*
Your answer
Do you feel your problem areas are being addressed and feel increased joint mobility following your massage session?
yes
no
Clear selection
how long is your ideal treatment session?
30 minutes
60 minutes
90 minutes
2 hours
Clear selection
Are you doing self-care at home between visits?
*
Daily stretches
Foam rolling
Corrective exercises
I would do self-care, but I am not sure what to do
Required
Are you interested in a care plan that incorporates massage treatment with corrective exercises and mobility training?
Yes
No
Clear selection
I understand that muscle health and wellness takes daily commitment and effort. Additionally, I would be able to commit the following time into muscle health with a care provider
*
30 minutes 2x per month alternating massage and training
30 minutes 4x per month alternating massage and training
60 minutes 2x per month
60 minutes 4x per month
None of these
I am only interested in massage and relaxation. I prefer the following schedule.
1-4 massages per year
5-12 massages per year
1-2 massages per month
Clear selection
Thank you for taking time to fill out the above questions.
Your answer
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