Touch Therapy Clients Form

Please fill out this form after Booking a Session. This information will help me to adapt the Session for your individual needs and wishes.

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Name *

First

Last

Email *

Pronouns *

Are you allergic to anything? *

if not please type „x“

Did you have any injuries/surgeries? *

if not please type „x“

Do you have any chronic diseases ? *

if not please type „x“

What parts of your body bother you? *

Do you feel pain, discomfort in certain areas of the body? if not please type „x“

Please place an X beside any symptoms you experience: *

What do you expect from a session ? How do you want to feel after? *

Any traumatic experience you want me to know? *

if not please type „x“

What is your favorite body area to massage? *

What makes you feel relaxed? *

What is your favorite scent? is there any scent you don’t like? *

bother me? you

Anything else you want to tell me? *