top of page

HOME
PHILOSOPHY
STAFF
OUR SERVICES
CONTACT
More

Use tab to navigate through the menu items.

Intake Form

Personal Information

First name*

Last name*

Birthday

Year

Month

Day

Gender

Male

Female

Phone*

Email*

Full Address*

Alberta Health #*

Occupation

Emergency Contact

Emergency Contact Name

Emergency Contact Phone #

Relationship

Reason for Massage Therapy

Referred By

Have you had a therapeutic massage before?

Yes

No

Address:

5223-55 Ave NW, Edmonton, AB, T6B 3V1

Hours:

Mon: Closed

Tue to Sat: 9AM to 8PM

Sun: 10AM to 5PM

bottom of page