New Massage Client Form | Olga’s Oasis

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Massage and Spa Intake Form

First name*

Last name*

Phone*

Email*

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Address*

Birthday*

Day

Month

Year

Occupation*

Gender Identity

Amount of stress in your life (1 - low, 5 - high)*

Please select any painful or tense areas as well as regions that you hold your stress.

Head/Face

Low Back

Shoulders

Neck

Abdomen

Legs/Feet

Arms/Hands

Mid-back

Other

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Bookings

Tel: 0413 605 434

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