How Often Do You Experience Pain?

Almost Every Day

A Few Times A Week

A Few Times A Month

Rarely, it comes and goes

How Much Does Pain Impact Your Daily Life?

Barely noticeable

I notice it but can manage

It slows me down or makes things harder

It stops me from doing what I love

Where do you feel the most pain or tension?

Pain Location

Neck & shoulders

Lower back

Hips or legs

Full body fatigue

What’s been holding you back from getting a massage?

Massage Obstacle

Time — I’m too busy

Money — it feels like a luxury

I’m not sure it would really help

I just haven’t gotten around to it

I already get massages regularly

What would you most like to feel after your next massage?

Desired Outcome

Pain-free and loose

Calm and mentally clear

Energized and refreshed

Recovered and ready to move

All of the above

Would you be open to an in-home massage that comes to you?

Yes — that sounds perfect

Maybe — I’d like to learn more

Not sure yet, but I’m curious

What Is Your Name?

What Is Your Best Phone Number? *

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