Greenfield Massage New Client Client Intake Form Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Is texting ok? Yes No Preferred form of Communication * Text Email Phone Health Information Occupation Describe your current exercise or sports activities if relevant Allergies Oils Lotions Nuts Fruits Other Is there any other health information that I should know (injuries, surgeries, or accidents)? Massage Information Have you had a massage before? * Yes No What type of bodywork have you had in the past? Reasons for seeking massage (Relaxation, injury, or specific concern) How much pressure do you prefer? Light Medium Firm Not Sure Select what you are interested in below Microwave Moist Heat Pack Infrared Heat Therapy Pad Table Warmer Biofreeze Essential Oils - $5 Add-On Upcharge Cannabis Salve Any additional information? Enter Your Full Name Below to Sign this Document Today's Date MM DD YYYY Thank you!
