Intake Form | The WeHive

First Name & Preferred Name (if applicable)

Email Address

Phone

Last Name

Your pronouns

Address (required for housecall requests only)

Occupation

What is your reason for seeking bodywork right now rather than at another time? Your answer helps me understand the current context of your life so that I can best serve you at this moment.

How did you hear about my practice? If referred, please share by whom so I may thank them!

Emergency contact name & phone number

I have provided all known medical information. I acknowledge that massage therapy/ energy work/ yoga is not a substitute for medical diagnosis and treatment. I give my consent to receive treatment. Please type your full name:

I acknowledge I am consenting to receive a strictly professional and clinical therapeutic massage/ yoga lesson. Absolutely no inappropriate, suggestive or sexually threatening conduct or language will be tolerated. Should this condition be violated, the session will be immediately ended. Please type your full name:

Cancellation policy: At least 24 hours cancellation notice is required for all bookings. A 50% charge will apply to all bookings cancelled within the 24 hour window, due at the time of cancellation. In acknowledgment, please type your full name here:

Covid consent: I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. Please type initials:

Digital Signature

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New Client Intake & Covid Consent Form