Name *

First Name

Last Name

Phone *

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What are your current needs? *

Please list ALL that may apply to you.

I am looking for a relaxing massage.

I am looking for massage for emotional release and stress management.

I am looking massage for physical pain.

I am experiencing sudden onset of pain.

I am experiencing chronic pain and am looking for routine care.

I am experiencing overwhelming stress.

I just need massage once in a while.

I am looking for ongoing, routine appointments as part of my chronic pain managment.

I am looking for ongoing, routine appointments as part of my self care.

I really don't know what I need right now but you were recommended to me.

I am interested in Yoga support.

I'd like help in establishing and maintaining a healthy life.

I need support with Lyme concerns.

I'd like to help support your medical massage missions.