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Client Intake Form

Help me to Best serve YOU!

Are you currently pregnant?
Do you have any allergies or sensitivities?
Have you had a professional massage before?
What type of massage are you seeking?
What pressure do you prefer?
Are you open to receiving any energy and sound work to enhance relaxation and restore balance to the subtle body? A Palo Santo or Sage smudge, Reiki, Tuning Forks, Singing Bowls and/or Crystals placed on the chakras.
How would you rate your nutrition?UnhealthyOpen to learning and trying new thingsOrganic, fresh, local.Excellent-cook daily, balanced mealsNutritionistHow would you rate your nutrition?
What is your current lifestyle?
What are you most curious to learn in Yoga and the mindbody connection?
What do you struggle most with?

Thanks for submitting!

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