New Client Intake Form — Liz Haunstein, LMT

Email

Occupation

When was your last massage?

When was your last CranioSacral Therapy session?

Are you receiving other forms of complementary care (ex: chiropractic, acupuncture, physical therapy, etc)?

Please describe & include frequency

Where in your body do you experience tension, stiffness, pain or other discomfort?

Please describe

Please describe the issues that you have checked:

Do you have any medical conditions?

Do you have any particular goals in mind for this session?

Do you have any known allergies?

Please include allergies to food, cosmetic, environmental, etc.

Do you have preferences regarding massage?

In other words, is there something specific that makes a message really good for you? Please list any likes/dislikes you want to share here. What is your favorite thing about receiving a massage? How do you want to feel after the session is complete?

Is there anything else that you think would be useful to share?

How did you find out about us?

Referral, Google Search, Torus Spa Employee, Other? Please describe

New Client Intake Form - Please Complete Prior To your First Session.

New Client Intake Form - Please Complete Prior To your First Session.