Relax & Be Well, LLC 

Therapeutic Massage and Wellness Coaching  

Preferred Method of Contact (Please choose One)*
How would you rate your overall health?
Have you ever received a professional massage?*
Do you perform any repetitive movements in your work, hobbies, sports, ect.?*
Check all activities that apply to you*
Do you have stress in your work, family, or other aspects of your life?*
Have you had any recent accidents, injuries or surgeries (in the past 6 months)?*
Do you have any allergies/sensitivities to oils, lotions or scents? *
Do you have experience with Essential oils?
Please check ALL that apply
Musculoskeletal System*
Circulatory System*
Nervous System*
Respiratory System *
Skin *
Digestive System*
Waiver of Liability and Consent to have Massage*
Cancellation Policy*
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