SMART Bodywork® Preliminary Client Intake Form

If you already received confirmation of your scheduled massage session with our massage team, please complete the quick intake form below.

Name*

Email*

Mobile Phone*

Home Phone

Home Address*

Company / Job Title / Brief Description of work*

Notes (Area of need, recent injuries, surgies, allergies, and diseases or complications) (200-500 words)*

Are Home and Billing Address the same?*
YesNo

*If "No", please include your billing address below

Billing Address

Preferred Bodywork Location (price is dependent on location and selection of services*
Your Home (Note: Price and Additional Fees May Vary)Our Office (455 S Hudson St, Suite #300, Denver, Co 80246)Your Office (Note: Price and Additional Fees May Vary)       Hotel (Note: Price and Additional Fees May Vary)

I consent to receive bodywork support from SMART Bodywork® team (et. al.), and if ever dispute arises, I agree to seek arbitration and/or mediation between parties rather than filing a lawsuit.*
Yes

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