Creating Space Massage/CranioSacral Intake Form
Please fill this out at least 48-hours prior to your scheduled appointment. If you have any questions, feel free to reach out via phone or email, (518) 618-2298 creatingspace518@gmail.com
Name *
Your answer
Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Occupation *
Your answer
How did you hear about Creating Space? *
Your answer
Have you received a professional massage before? *
Have you received craniosacral therapy before? *
What are your goals for your session today? *
Your answer
Please list any medications you are currently taking?
Your answer
Please indicate any of the following conditions you have or had in the past?
Additional space if needed:
Your answer
Women: Are you currently pregnant?
Any other information you feel the therapist should know?
Your answer
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