Appointment Request

To ensure every session is safe, professional, and comfortable for both you and your therapist, please complete the brief screening questions below. This form protects the therapist’s safety, supports clear communication, and ensures we can provide the highest quality care.

Name (first and last):*

Phone number:*

E-mail*

Reason for massage therapy appointment:*

General wellness

Pain management

Doctor's referral

What are your scheduling preferences?*

Morning

Afternoon

Evening

I understand this is a strictly professional, non‑sexual service and agree to maintain boundaries, follow therapist instructions, and uphold the zero‑tolerance policy.*

Check the box if true