Shawna Stern, LMT's Client Contact Information
All new clients, please fill out the client contact information + health history and click 'submit' at the end. It should take about 10 minutes. Your information will be securely sent and securely saved and will only be accessed by your licensed massage therapist.

If you prefer a paper version, one will be available at the office before your visit. Please arrive 15 minutes early to your first appointment to fill this out.

Legal Name *
Your answer
Name I prefer to be called
Your answer
Preferred Pronoun (I go by she/her) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
How did you hear about us? *
Your answer
Best phone number to reach you *
Your answer
Email address (no junk, no sharing)
Your answer
Emergency Contact Name and Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
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