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Homebody Massage Intake Form

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First Name

Last Name

Phone Number

Email

Birth Date

Occupation

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Emergency Contact Name

Emergency Contact Phone Number

Relationship

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What is primary reason for booking an appointment?

What is primary reason for booking an appointment?

Are you experiencing discomfort in any of the following areas?

Are you experiencing discomfort in any of the following areas?

Select the TYPE OF PRESSURE you want used most of your massage session

Select the TYPE OF PRESSURE you want used most of your massage session

I use a combination of handcrafted whipped tallow and organic jojoba oil as my primary massage mediums. I find that tallow provides an ideal balance of glide and grip, allowing for slower, more intentional, and effective bodywork. Please indicate your preference below:

I use a combination of handcrafted whipped tallow and organic jojoba oil as my primary massage mediums. I find that tallow provides an ideal balance of glide and grip, allowing for slower, more intentional, and effective bodywork. Please indicate your preference below:

How did you hear about us?