Web Banner Design Request Form
Please complete the questionnaire in its entirety, Kristin has limited availability to accept new client appointments.
Preferred form of Contact
Prefer not to say
Height & Weight
Are you looking to use your health benefits to pay for your massage? If so please upload your insurance card at the bottom of the form and list your DOB.
What are your initial areas of concern? Please list any major medical conditions you may have
Describe your level of physical activity
What are your goals for seeking Barefoot Massage
Please list your preferred Days & Times for appointments & how often your like to receive Barefoot massage.
How did you hear about Kristin & Tri Barefoot Massage? Please be specific, we want to know who to thank.
Any additional comments
Attach insurance card
Upload a File
Should be Empty: