Membership Application
First & Last Name *
Phone Number *
Email *
I am applying for:*
The Premium Performance Plan
The Monthly Functional Plan
Occupation *
What is the single most important goal you hope to achieve through this membership?*
Have you ever been a member with a massage therapist before?*
Yes
No
Which monthly investment level are you currently comfortable with for your goals?*
$180
$160
$150
$135
$120
Do you plan to use HSA/FSA?*
Yes
No
When I go to get bodywork done, I see my therapist as:*
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.
How much time do you want to dedicate to bodywork per month?*
Once a week
Every 2 weeks
Every 3 weeks
Once a month
Tell me about your daily routine. Time spent at a desk? Sports? Etc...*
Any current conditions like high blood pressure, skin allergies, or recent surgeries?*
Seeing other specialists (e.g., chiropractor, physical therapist) for any conditions?*
I will make sure to read and adhere to all late, no show, and cancelation policies?*
Yes
No
What kind of pressure are you looking for?*
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?*
Yes
No
I understand that any inappropriate behavior/requests will not be tolerated?*
Yes
No
I understand that I will be professionally draped at all times?*
Yes
No