MFR New Client Intake Form

Myofascial Release- New Client Intake

Please fill out this form before your first session - 24 hours in advance is appreciated. All info is confidential. Thank you!
  • Please tell me about what brings you in for bodywork. Goals, intentions, desires.. what do you most hope to gain, shift, release, or experience from your session(s)?
  • Please list any history of surgeries, medical procedures, broken bones, or major injuries.
  • Please list any current or past medical conditions, including (but not limited to): issues with blood clotting, blood pressure, diabetes, heart conditions, malignancy, osteoporosis, rheumatoid arthritis, or open wounds.
  • Do you have a top-of-mind goal, desire, or intention for your first session?
  • Within the past fourteen days, have you had a postive test for Covid-19, travelled within a high risk zone, or experienced any symptoms that may indicate an active infection?
  • This field is for validation purposes and should be left unchanged.
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