Everything you share is confidential and helps Kimberly prepare the most effective session for you.

Full Name

Please enter your name

Email Address

Please enter a valid email address

Phone Number

Date of Birth

Please enter your date of birth

Is this your first visit?

Yes No

Primary goal for today's session (select all that apply)

Pain intensity in selected areas

1 - Mild 10 - Severe

Pressure preference

Light Medium Firm Deep

Any health conditions we should know about?

Anything else you'd like your therapist to know?

Booking and cancellation policy

A 50% deposit is charged when you book and goes toward your session.
Your card stays on file, and the balance is charged after your session.
Cancel or reschedule 24 hours ahead and your deposit is refunded or moved once. Inside 24 hours, or for bookings made less than 24 hours ahead, the deposit is kept.
A no-show, or a session ended for safety or conduct reasons, is charged the full price.
Any client may be asked to complete a quick routine photo ID and selfie check.
Gratuity is not included and is always optional.

✓I have read and agree to the booking and cancellation policy

Please confirm you agree to the policy

✓

You're All Set

Thank you for completing your intake form. Kimberly has received your information and will review it before your session. If she has any questions, she'll reach out directly.

We look forward to helping you feel your best.

Book Your Session

Pre-Session Intake Form

Where Are You Feeling Tension?

Front

Back

Tell Us About Your Needs

You're All Set

Your Healing Starts Today