Asheville Massage Therapy

Massage Intake Form

Please submit an intake form prior to your first visit.

Your Name: - Required
Email: - Required
Date of Birth:
Address:
Phone:
Occupation:
How did you hear about Blaizing Lotus?
Desired appointment:
How long of a session do you want?
Do you tend to get cold or hot easily?
I prefer
Are you redeeming a gift certificate?
Will this be your first professional massage?
If no, are you massaged regularly?
Are you interested in assisted stretches?
Would you like to schedule a Spa Treatment today?
If yes, which one(s)?
Type of massage you prefer:
What kind of pressure do you prefer on a scale of 1 to 5?
Musical Preference:

Please list:

Please list:

Please list:
Months:
Do you have any of the following today:
Please explain, along with any other conditions that may be of concern:
What is your intention (goal/expectation) for this treatment?
Each massage includes aromatherapy.
CLICK HERE to choose aromas for this session
 
Check the areas you would like me to put more focus on (if any):
Check the areas you would like me to avoid (if any):
If you'd like to add something, please do so here:
  • All massages are draped, following a professional code of conduct and ethics.
  • Sexual remarks or advances will terminate the session and client liable for payment of the scheduled treatment.
  • Being that massage should not be done under certain medical conditions, I affirm that I have answered all questions pertaining to medical conditions truthfully.
  • I will inform my therapist of any changes in my medical status.
  • I will inform my therapist if I need the pressure to be adjusted, or experience any pain or discomfort during my massage.
  • I will inform my therapist ahead of time if I have to cancel, or plan on being more than 15 minutes early or late to my scheduled appointment.
- Required




~ The ROSE ~

Rose Package
($100 for 60 minute massage and $120 for 90 minute massage)

~ The LILY ~

Lily Package
($150 for 60 minute massage and $170 for 90 minute massage)

~ The LOTUS ~

Lotus Package
($200 for 60 minute massage and $220 for 90 minute massage.)