STRETCH THERAPY FORM | Trained By Tish

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START YOUR STRETCH JOURNEY HERE

First name*

Last name*

Email*

Phone*

Occupation*

Birthday*

Month

Day

Year

Emergency name & contact information *

Are you under the care of a physician? If so, why?*

Have you ever worked with a body worker before? If yes, how often? What kind?*

Are you pregnant? *

Yes

No

Do you have high blood pressure?*

Yes

No

Have you broken any bones in the past 2 years? If so, which ones?*

What pressure do you prefer?

Light

Medium

Deep

How many hours do you sit a day?*

What are your current issues and for how long?*

What movements provide discomfort or tightness?*

Are you allergic to any fragrances and/or scents? If so, please state which ones. *

4. Do you have some concerns about breathing? What about during exercise?*

What type of music station or playlist helps you unwind?

CONTACT ME

WRITE OR CALL ME IF YOU HAVE MORE QUESTIONS

(510) 542-7717

@2024 MORIAHELIYAH DESIGNS

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