Client Intake Form

This form will give me the information I need to properly understand and plan your massage session.

Please answer the questions and click the Submit button at the end.

This information will be sent to me securely and privately and will not be stored on a server.

    Personal Information


    Medical Information

    (If not, leave blank)

    (If not, leave blank)

    Some useful information

    • Address: 235 Chaparral Valley Way, Southeast, Calgary T2X 0X3
    • Phone: 403-616-16-01
    • (use for eTransfer)

    More info about your first visit