Full Name *

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

Can you tell me 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

When did it start?

Have you tried previous treatments for this?

Chiropractic

Physical Therapy

Pain Specialist

Massage Therapist

Dietary Changes

Personal Training

Yoga/Pilates

Other

(If Any) 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

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

Mornings (8 am - 12 pm)

Afternoons (12 pm - 4 pm)

Evenings (4 pm - 8 pm)

Weekends

Other

If your plan includes multiple sessions, are you prepared to commit to a consistent treatment schedule to get the best results?