Balanced Newtrition
A New Way to Nourish the Mind, Body, and Soul
Keith Massage Client In-Take Form
In the state of Texas, we required to keep a client intake form on all current massage clients. The state requires us to gather specific information for your safety and ours.
To help cut down on the amount of paper we consume, we are asking everyone to take a moment to fill out the following form. This form MUST be filled out entirely.
The state also requires us to update our client intake forms every two years. So, whether you're an existing client or new to our office, we will need you to take a moment to fill out this form unless you've been notified otherwise.
Your information is completely confidential, nor is your information ever sold to a third party.
As always, we continue to provide the very best quality in service and client care as we continue to do what we love; Helping Others Feel Good!
For those of you that do no wish to fill this form out online, we will be providing you a paper copy on your next visit, which will need to be filled out before your session.
Thank you for your help and understanding!
NOTE: Anything with a * must be filled in or the form will not submit. This means you will receive an error message that the form did not go through. Please be sure to fill out all * as instructed to ensure a good send.