Required Client Information:

Name:

Address

Land/Region

Adresse

Stadt

Postleitzahl

Date of Birth:

Tag

Monat

Jahr

Please provide a way to contact you: *

Email

Phone

Make an Appointment:

Which service do you want to book?

Please share when you would like to make your appointment. Is there a certain day of the week or times (morning/afternoon/evening) that work best for you?

Have you experience massage therapy before?

Yes

No

What is the purpose of your visit? How can Massage Baum best support you?

Health and Medical History:

Are you currently suffering from pain or tension? Any injuries?

Do you suffer from any health problems? Please be honest and share all relevant information:

If yes, what are you currently doing to treat it?

Have you recently or in the past undergone surgery?

Do you have any allergies or any other health concerns that might affect you during massage?

Is there any additional information about you or your body you would like to share?

Acknowledgement and Consent:

I have read the Book of Sacred Boundaries and agree to respect all boundaries so that we can both feel safe working together.

I understand that it is my responsibility to communicate and share my own boundaries. Everything I share will be taken seriously and respected.

I have familiarized myself with the price of the service and agree to pay in full. I understand that payment is only possible in cash at the time of the appointment.

I confirm that all information provided on this form is true, complete, and accurate. I will inform the massage therapist about my current condition at each visit.

Space to Share:

If you'd like to share anything else now, this is the place to do so. You can share any thoughts, concerns, expectations, or boundaries in this space.

If you don't feel comfortable writing or sharing anything right now, that's okay too.

Before we begin our massage ritual, we always take time to have a conversation. You can always speak and share anything at any time during your appointment.

This space is open for you :)

holistic massage studio

Client Intake Form

Required Client Information:

Make an Appointment:

Health and Medical History:

Acknowledgement and Consent:

Space to Share: