Client Intake Form

This form consists of the following sections:

All of your information is kept completely confidential.

Your Information

First Name *

Last Name *

Email *

Phone *

Date of birth

Occupation *

This helps me understand how your work may affect your body, posture, or movement patterns.

Emergency Contact Full Name *

Emergency Contact Phone Number *

Relationship *

What days and times do you generally prefer for sessions? *

What types of adjustments are you comfortable with during our sessions? *

Hands-on adjustments, as needed

Verbal cues

Not sure yet

Would you like to join the studio’s online community? *

Yes

Maybe later

Connect with other members, find a duet partner, and more!

Do you have any questions for me, or anything else you’d like to share?