Skip to main content

Turn Your Pain and Tension to Tranquility

Complete Your Intake

Scroll Down To Learn More

Welcome to Lisa Secora Massage and Recovery! We’re excited to embark on your wellness journey with you. To ensure that we provide you with the best possible care, please take a moment to complete this intake form. Your responses will help us understand your specific needs and tailor our services to meet your expectations. Rest assured, your information will remain confidential and is solely for the purpose of enhancing your well-being. Thank you for entrusting us with your care, and we look forward to providing you with an exceptional experience.

About You

Your Name(Required)
Date of Birth(Required)
Address

Emergency Contact

Name(Required)

Help Us Provide You With The Best Experience

Primary Reason for Seeking Massage or Stretch Therapy(Required)
Areas of Focus(Required)
Preferred Pressure Level(Required)
What level of pressure would you like to experience to relieve your muscles?

Medical History

Please, let us know about any medical conditions that may impact your experience.
Please, list all medications you're taking. Some medications may impact blood flow, heart rate, and other areas of the body.
Please, tell us about any allergies or skin conditions you are aware of, including, food allergies, skin allergies, etc.
Consent and Acknowledgment(Required)
This field is for validation purposes and should be left unchanged.

Turn Your Pain and Tension Into Tranquility