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FINAL Evergreen Holistic w description P

Call (941) 423-5409
OPEN 7 DAYS A WEEK

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Client Intake Form - Therapeutic Massage/Bodywork

The following information will be used to help plan safe and effective massage sessions. Please answer the questions to the best of your knowledge.

Personal Information:

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

No

Yes

Date

Initials

I confirm that the information given in this form is true

Phone

Thanks for submitting!

Appointment Availability:
Monday: 8:30am - 6pm
Tuesday: 8:30am - 5:30pm
Wednesday: 10am - 4pm
Thursday: 10am - 6pm
Friday: 10am - 6pm
Saturday & Sunday: 8:30am - 5:30pm

Please note: we do not hold office hours. Doors will open 15 minutes before the start of your session time. If the door is locked we are either in session or preparing the room for you.

Location
2525 Bobcat Village Center Road
Unit 104
North Port, FL 34288
(941) 423-5409

Est. License: #MM40752

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© 2020 by Evergreen Holistic, Inc. Proud to be locally owned and operated. All rights reserved.