Client Intake Form

If you have already filled out an intake form, click here to book an appointment.

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I am here today for: (click and fill out all that apply)

By checking the box below, I certify that I am the above named person, that the above information is accurate, that I agree to the above terms and conditions and I understand that because massage should not be done under certain medical conditions, I have answered all questions pertaining to medical conditions truthfully. I forever release Blaizing Lotus of any unfortunate and highly unlikely event of injury resulting from any and all agreed therapeutic services.

I agree to the terms and conditions