Ann Buckner's Massage Therapy
1st time Client Form


Intake for Ann Buckner's Massage Therapy


Name                                  Age

Cell Phone                         E-Mail                     


Write below, any physical challenges you would like this therapy to address. Then state if you have any;

1) allergy to any aromas or oils

2) medical conditions

3) Flu or cold








I understand that this is not medical treatment. Rather that this is bodywork applied to the body to bring balance to body systems. I also understand that after treatment I must drink 2 more glasses of water than is normal for me and avoid physical exertion until after a nights sleep








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