Language
  • Français
  • English (US)
  • Image
  • Personal Information

    Please fill out my new patient form so I can know you better and best serve you. After the form is filled, you can set up your first appointment.
  •  - -
    Pick a Date
  • Thank you for your interest, but Bethany is only accepting female clients at this time.

  •  -
  •  -
  • Massage History/Treatment Information

  • Previous History

    Include year and treatment received
  • Health History









  •      It is my choice to recieve massage therapy. I realize that the treatment is being given for the well-being of my body and mind. Treatment benefits may include stress reduction, muscular tension, spasm or pain relief, as well as increased circulation or energy flow. I agree to communicate with my massage therapist at any time I feel that my well-being is being compromised.

         I understand that the massage therapist does not diagnose illness, disease or any physical or mental disorder, nor does she prescribe medical treatment, pharmaceuticals, or preform spinal manipulations. I acknowledge that massage is not a substitute for medical examination or diagnosis and that it is recomended that I see a primary health care provider for that service.

         I have stated all medical conditions that I am aware of and will update the massage therapst of any changes in my health status.

  • 24h cancellation policy

  •      All cancellations must be received at least 24h before your appointment in order to avoid being charged. Clients who do not cancel with 24h notice will be charged the full price session they were scheduled for. We understand that emergencies happen. We provide every client with one free short-notice cancellation. You will not be charged for your first cancellation with less than 24h notice. Subsequent short notice cancellations will result in being charged the full price of the session. The free short-notice cancellation only applies if you notify the front desk or massage therapist prior to the session start time. No shows are not eligible for the free cancellation.

  • Client informations - Signature

  • Clear
  •  - -Pick a Date :
  • Should be Empty: