Intake Form

What kind of treatment are you looking for? *

This is just a guidance for therapist. It's essential to manage expectations, as dramatic results in a single session may not always be attainable.

JUST FIX ME : Regular visit weekly are encouraged untill the pain is lessen. PACKAGE purchase IS HIGHLY recommend! Just good deep tissue/sports massage .: Good for keeping as maintenance/ enhance sports performance/ prevent injury/ enhance muscle recovery)

Gender *

Male Female

Would you like to have conversation with therapist during treatment? *

Yes No Maybe

How much of pressure do you prefer? (1-10) *

No pressure Very firm

How bad is the pain? (1-10) *

No pain Worst pain you have in your life.

Last 4 digits of your Phone Number *

Full Name *

Age *

Occupation *

Sports/Exercise/Hobbies *

Area of pain or tension that need attention. *

eg. right shoulder, both side of low back. Please be specific.

Any surgery or injury that therapist should know and have we asked everything that is important to you? *

eg. got hip surgery 1 month ago, on blood thinner medication