COVID-19 Forms | Jessie Duncan Wex, LMT

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JESSIE DUNCAN WEX, LMT

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COVID-19 Forms: Services

Massage Intake

Please fill out the following form before your first session to help me understand you better.

First Name

Address

Email Address

Last Name

Date of Birth

Phone

What are your preferred pronouns?

What about your body and/or lifestyle feels really healthy?

What are your goals and intentions for this session?

Please list all allergies

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

I want to subscribe to the newsletter.

Thanks for submitting!

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Phone: 971-412-2299

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