Awaken Healing + Massage 
Please fill out the form below to the best of your ability. Thank you for investing in your self care and choosing Awaken Healing + Massage to be a part of your healing journey. Please know that none of these questions are required, yet are a way to be able to give you the best results on all levels of the Self.  This is referring to the physical, mental, emotional, and spiritual parts of our selves.  The minimum required fields have an * in red. 
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Email *
Name *
Birthday  *
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Phone Number:  *
Emergency Contact and Name:  *
Have you received massage therapy before?  *
Have you received energy work before?  *
Have you received sound healing before?  *
What are you reasons for this session?  *
Do you suffer from chronic pain (pain that has been present for 6 months or more)? If so, please explain. What makes it better? What makes it worse? 
Have you sought care for today's issues through other means? 
Does this affect other areas of your life? 
How committed to your healing do you feel? 
not committed
very committed
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Do you have a spiritual practice or attend any spiritual services? If so, what do you call your Connection with Spirit, the Divine, God, Jesus, Universe, Source etc.? 
What do you do for yourself on a regular basis? 
What do you do for others on a regular basis? 
What makes your heart happy? 
Do you spend time outdoors? 
Do you read?  If so, what is your favorite book or the last book that you read? 
Do you do your own grocery shopping? cooking? 
Do you listen to music? What kind? 
Do you fall asleep easily? Do you stay asleep through the night? 
Do you dream? Do you remember your dreams? 
Do you have a list of written goals? Do you reference them often? 
Do you have a schedule/routine, or do your days vary? 
Are you seeking therapeutic massage, relaxation massage or a combination of the two? This could be written as a percentage i.e 80% therapeutic, 20% relaxation 
Do you have a pressure preference? ( light, medium, deep tissue work) 
What kind of music do you enjoy listening to while in session? 
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Do you like heat in your session? i.e table warmer, hot stones, hot bamboo, hot towels 
If not,  please specify below. 
Do you have any allergies? Smell sensitivities?  ( Please note, I utilize chemical free detergents and cleaners, Young Living essential oils, and Young Living massage oils to ensure top quality care)  *
Do you take any medications? If so what are the called/ what are they for?  *
Are you currently pregnant? If so, how far along are you? Are there any high risk factors?  *
Have you had any orthopedic injuries? If so, please explain.
  Please indicate any of the following that apply to you. 
Please explain any conditions you have marked above:
  Are there any areas (feet, face, abdomen, etc.) you do not want massaged? If so, please explain.
Is there anything else you would like me to know before session? 
Things to Know Before  Session & Post Session 
If it is your first session, please arrive 5 to 10 minutes prior to be able to discuss your intake form. 

Take time to set intentions prior. This could be as simple as I want my pain in my neck to go away to I want to create more balance or gain insight to a specific question you have in your life. This is not even necessarily something to share with me. It is simply advised to just take a moment to consciously connect to the your Inner Wise Self. To receive optimal care on all levels for you, this is connecting into the mental and emotional bodies that I view to be just as important as the physical body aspect of the massage therapy/bodywork/energy work process.   


It is recommended to bring a water bottle so you have water to drink prior and most importantly post session to support the body in flushing out any toxins released from the body.  

It's recommended to have some time to enjoy the state of relaxation achieved from your session.  If you have any questions or concerns post session, please contact us so we can support you on your healing journey beyond your massage sessions. 


We are honored you have chosen Awaken Healing + Massage to empower you on your health and wellness journey! 


Rescheduling/Cancellation Policy 
If you would like to add services or change the date/time of your appointment, please do one of the following:

1) Cancel this appointment and book again (at least 24 hours prior to the current date/time)
2) Call/text us at (417) 450-8875
3) Send an email to awakenhealingmassage@gmail.com with the changes you prefer

LAST-MINUTE CANCELLATIONS
If you cancel your appointment within 24 hours of the scheduled service or do not show up to a scheduled appointment, the card on file will be charged for the full amount of the service. If your last-minute cancellation is due to sickness or an “emergency” situation, the amount charged for your original appointment will be determined by your practitioner.

CANCELLATIONS OR RESCHEDULING
If you reschedule or cancel your appointment more than 24 hours before your scheduled service, no charges will be made to the card on file until you receive the service and authorize the charge.

Repeated cancellations or no-shows may require pre-payment before booking.

LATE ARRIVAL
If you are more than 15 minutes late for your appointment, we may not be able to provide the complete service for which you have been scheduled. We will make every effort to make sure you receive the remaining amount of time of your appointment and you will be charged for the full amount of the original booking. If it is impossible to provide the service in the time remaining of your scheduled appointment you will be asked to reschedule. The amount charged for your original appointment will be determined by your practitioner.

Thank you for your consideration and understanding.

Payment will be processed after your service is provided. If you would like to add a tip, it can be done at that time. 





  By typing your name below, you agree to the following.
 I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time.  I also agree to Awaken Healing + Massage's cancellation/rescheduling policy mentioned directly above this section on the intake form. 
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