Massage Therapy & Body Treatment

*First Name
*Last Name
*Email
*Have you ever had a professional massage? (do not include chair massage)
*How often do you receive professional massage therapy?
*Date of your last massage (can be approximate)?
*Other stress reduction modalities & frequency? (i.e. yoga, meditation, etc)	required
*What results do you want from your massage sessions?	required
*Indicate preferred depth of massage pressure
*Prioritize top 2-4 areas in a therapeutic professional massage that you enjoy most.	required
*In a therapeutic professional massage, is there an area that you do not wish to be massaged?	required
*Are you ticklish, very sensitive to touch/pressure in any area? Where?	required
*Have you ever received body treatments? Type (scrubs, wraps, cellulite treatments, etc)?	required
*Do you have claustrophobia? Explain.	required
*Do you have areas of cellulite you are concerned about & where?	required
*Do you have any such known body product or ingredient allergy? (Choose one here, type others below.)
*List other known body product or ingredient allergies. Explain.	required
*Please rate the level of stress in your life overall at present.
*Please rate the level of stress in your life overall during the past 12 months.
*Please indicate areas of pain, tension or other discomfort. (Choose one here, type others below.)
*List other areas of pain, tension or discomfort.	required

Love Thyself Day Spa