Client Intake | Calm Horizons

Client Intake Form

To ensure a smooth and enjoyable experience, we kindly ask all new clients to complete this one-time intake form. Please fill out this form before booking your first massage. Your cooperation is greatly appreciated.

Thank you!

Personal Information

First Name

Last Name

Address

Referred By

Emergency Contact

Phone

Occupation

Physician Name

Physician Phone

Emergency Phone

How Would you rate your general health

Poor

Good

Fair

Excellent

Have you ever had a professional massage before?

Yes

Discribe injuries. concerns, or issues to address + causes and dates of occurrences

Describe your treatment goals

Client Intake Form

Personal Information

Calm Horizons

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