Please fill out the fields below. Or, [download the intake form here] and email completed form to

Feel free to ask any questions, and I look forward to working with you!

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Are you currently under medical treatment?
Do you currently have or previously had recently any of the following conditions?
Please select all that apply. Or "None" for no conditions.
Consent Statement 1
I understand that massage therapy involves neither the diagnosis nor treatment of any condition and is not a substitute for medical care. Draping will be used for the entirety of the session.
Consent Statement 2
If I am uncomfortable for any reason, I may request to end the session and it will end promptly. If a client is under the age of 17, written consent from a guardian or parent is required. I affirm that I am able to receive massage therapy and that any information provided above does not prohibit me from doing so.