2025 Client Intake Form - Melanie Joye LMT
Fill out the intake form to be added to the waitlist & given access online booking system. Please pay attention to the agreements in section 2 so we begin to work together as fully informed as possible. Everything is confidential. I'm glad you're here! This is a lot of info & I promise it is all important for informed consent & complete safety.
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Email *
First & Last Name: *
Cell Phone:
Number will be added to your online booking profile for text reminders. Add 615.905.6585 to contact me!
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Address:
Street City State ZIP
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Date of Birth: *
MM
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DD
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YYYY
Emergency Contact:
Name, Number, Relationship
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Referral Contact:
How did you hear about me?
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Occupation & Mobility:
This helps me understand your daily movement, potential routine & structural patterns.
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Injuries: surgeries, accidents, broken bones, sprains, wounds, etc. Please include dates of injuries!
Common contraindications for bodywork include communicable diseases, certain allergies, cancers, fever, rashes, blood clots, long flights day of session. If you are pregnant, please get clearance from your doctor.
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Health Care Team: 
Other practitioners, therapist, PT, chiropractic, medical, etc
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Health Care Support: 
Meds, supplements, etc
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Allergies or sensitivities: 
Scents, peanuts, animals, oil/lotion, etc ~ please let me know if you prefer Clementine crated or free! If you are allergic to dogs, pls LMK so I can vacuum before sessions that day.
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Pain Points: 
What are your goals for our sessions together?
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Booking Preferences:
What sessions are you interested in? I encourage you to book out 3-4 sessions as your schedule & budget allows. You can book online up to 60 days in advance. If you prefer to create consistency, we can book 2-12 months in advance together.
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Required
Is there anything important you want me to know? What goals & intentions do you have for our work together? *
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