Would we work well together?

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Full Name *

Phone *

Email *

What is your primary reason(s) for seeking care? (Select all that apply) *

Can you tell us more about your primary reason(s) for seeking care?

Is this a recurring challenge you've experienced before?

Yes it's happened in the past
No this is a new problem

What massage techniques have worked for you in the past?

Long flowing massage strokes

Specific pin-pointed pressure held for a period of time

Combination of long flowing and specific pin-pointed strokes

Stretching incorporated into the massage strokes

Deeper pressure

Firm but comfortable pressure

Lighter pressure

I usually let the therapist decide since they are the professional

Based on our discussion we recommend the therapist should work on:

The specific Area(s) we discussed

The entire body with a majority of the time spent on the specific area(s)

Only a full body massage

Maintenance techniques for continued results attained through massage

What days and times are best for your appointments? (Select all that apply)

If Accepted Into A Precision Program, Are you willing to commit to a regular treatment plan?

Who referred you to us?

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