Client Information
Please fill out this form as best you can so we can provide you with the most relevant service.
First Name
Last Name
Email
Phone Number
Birthday
Why are you interested in our service?
Have you had bodywork or coaching before? How was your experience?
What is your physical health history? Including illness, injury, accidents, and surgeries.
What is your mental health history? Including habits of the mind and doctor diagnosis.
Do you have any allergies?
Are you currently under treatment of a physician and/or mental health therapist?
Are you currently pregnant?
Tell me about your sleeping and eating habits
How do you stay active? ie. dance, exercise, sports, walking
What are you current interests and/or hobbies?
Are you willing to take responsibility for your wellness journey and implement the practices, lifestyle changes, and mental shifts that are required to live a life where you thrive with optimal wellness?
Yes, I'll do whatever it takes!
I want to say yes, but I am already pretty busy. It's hard to find time to take care of myself.
Maybe, I am resistant to make a lot of changes. I don't want to distrupt my life's rhythm.
Absolutely not. I expect you to do all the hard work for me. That's why I am paying you right?!
I don't know. Can we talk about it?
Do you understand our cancellation policy? If you cancel your appointment within 24 hours of you session, you will be charged with 100% of your service fee.
I understand the cancellation policy. I will be charged the full fee if I cancel within 24 hours of my appointment
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