Let’s work together

Name *

First Name

Last Name

Address of residence *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

What brings you to a desire for bodywork? *

Relax

Injury

Stress

Wellness maintenance

Other (not sexual related aims)

Is massage intended to be, or already a regular part of your life?

Yes

No

Maybe

Are you interested in on-site care in SW Portland, or in a mobile service? *

On-site in SW P-town

Mobile - At my home or office

Mobile - At my Air BnB

Mobile - At my Hotel

If you intend to get an on-site service here in SW Portland, could the presence of a cat pose any health or wellness issues for you? *

We share this treatment location with a friendly cat

No

Potentially, but it will not be a concern

Yes

Not applicable to me

How long of a session are you currently interested in? *

60 minutes

90 minutes

Around 120 minutes

As long as needed

Do you have any sensitivities or injuries the therapist should be aware of? *

Possible sensitive skin, sensitive to scents, or to sounds/music

Current/prior injury, possible other delicate areas or limited mobility

Allergy or other relevant medical concern

Other

None

Do you have any skin or nail conditions your therapist should take caution to avoid? *

The therapist will need to avoid these areas to avoid contracting or spreading these concerns

Itchy or raw patches, athletes foot, or other skin irritations

Warts, toe nail fungus, or other irregularities

Other

None

What depth of massage pressure do you generally enjoy? *

Choose one or multiple

Light only

Light to medium

Medium

Medium to deep

Generally firm

Deep tissue on targeted areas in need

As the therapist recommends

A mix, I just like a good therapist

Do you agree to communicate any uncomfort you may experience that you do not intend for your session? *

The therapist will also pay attention to body cues

Yes

Would you be interested in essential oil use within your session?

Yes

No

A credit card on file will be required for booking services *

Your card is not charged until the time of service

No problem... happily

Do you agree to the no-show and cancelation policy of HHH? *

Cancelation under 24 hours notice = Charged 50% the cost of booked service No-Shows = Charged 100% the cost of booked services

Absolutely. I am accountable to my commitments and respect time put aside for me

What methods of communication are ideal for follow up about scheduling? *

Contact etiquette for quality care: When provider contact information is acquired, it should be used only for service-related communications, which may include sharing your valuable feedback.

A phone call

Text

Email

Whatever works

Where did you hear about Holistic Healing Harbour? *

Business card

Google search

Yelp

NextDoor

Referral

Safari

Other

Do you agree to never solicit your therapist for any sexual attention? *

Your therapist has the right to end a session early and charge for the full length booked, if this is disregarded.

Yes