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Membership Application
First & Last Name
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Phone Number
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Occupation
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Email
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Please enter a valid email address.
I am applying for:
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THE FUNCTIONAL PERFORMANCE PLAN
THE PREMIUM PERFORMANCE PLAN
THE COUPLES PREMIUM PERFORMANCE PLAN
How much time do you want to dedicate to bodywork per month?
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Once a week
Every 2 weeks
Every 3 weeks
Once a month
What is your duration Preference?
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60-Minutes
75-Minutes
90-Minutes
What is the single most important goal you hope to achieve through this membership?
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Do you plan to use HSA/FSA?
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Yes
No
When I go to get bodywork done, I see my therapist as:
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A professional who is trained to facilitate my body's own healing process.
A service provider who performs a physical labor service I am purchasing for the hour.
I will make sure to read and adhere to all late, no show, and cancelation policies?
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Yes
No
Tell me about your daily routine. Time spent at a desk? Sports? Etc...
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Any current conditions like high blood pressure, skin allergies, or recent surgeries?
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Seeing other specialists (e.g., chiropractor, physical therapist) for any conditions?
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What kind of pressure are you looking for?
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Therapeutic pressure that may vary depending on what is optimal for my body's healing in the moment
Maximum pressure no matter what is actually optimal for my body's healing at any given moment
I understand that all sessions are therapeutic?
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Yes
No
I understand that any inappropriate behavior/requests will not be tolerated?
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Yes
No
I understand that I will be professionally draped at all times?
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Yes
No