SOUL SPA

Client Intake

Please take a moment to share your details so we can offer you a safe, personalized experience.

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Personal Information

Tell us a little about yourself

FIRST NAME

LAST NAME

PHONE

ADDRESS

CITY

STATE

ZIP CODE

DATE OF BIRTH

EMAIL (OPTIONAL)

Your address will be verified before this form is accepted. Please enter your current home address exactly as it appears on your identification.

HOW DID YOU HEAR ABOUT US?

WHICH SERVICE ARE YOU HERE FOR?

Select at least one.

Head SpaBody MassageFoot MassageFacial

Please select at least one service.

Medical Information

Your health helps us care for you safely

Please mark all that apply to you:

EXPLAIN ANY CONDITIONS YOU HAVE MARKED ABOVE

Massage Information

Help us tailor your treatment

What type of massage are you seeking?

RelaxationTherapeutic / Deep Tissue

OTHER

What pressure do you prefer?

LightMediumDeep

WHAT ARE YOUR GOALS FOR THIS TREATMENT SESSION?

PLEASE DESCRIBE ANY AREAS OF DISCOMFORT

By signing below, you agree to the following: I have completed this form to the best of my ability and knowledge. I agree to inform my therapist if any of the above information changes at any time.

I have read and agree to the statement above.

Personal Information

Medical Information

Massage Information

Thank you.