Is barefoot massage right for you?

You deserve the best and we aim to please. In order to determine if our services are the right fit for you, please fill out this form and let us know how we can help so we can get you the best care for your body.

The more you share the better we can help

Name *

Name

First Name

Last Name

Email Address *

Phone

(###)

###

####

What are you hoping to get out of a massage? *

If pain relief is your goal, please tell us more... *

onset of pain, frequency, location...

Have you tried massage therapy for this purpose before?

yes

no

If so, was it helpful?

yes

no

How many hours per week do you spend sitting?

0-10

10-20

20-30

30+

How many hours per week do you spend stnading?

0-10

10-20

20-30

30+

How many hours per week do you spend exercising?

0-10

10-20

20-30

30+

If you have any questions or would like us to know more about your wellness needs, please tell us below:

Your information is held in confidence and will not be shared. We respect your privacy.

We’ll get back to you as soon as possible.