New Client Form

Please take a couple minutes to complete this new client intake form. The information provided will help me to best understand your needs and determine if MoonRoot Wellness is a good fit for you. I look forward to supporting your wellness journey! - Bri Vargas, Founder & Therapist

First name

Last name

Phone

What are your goals for your massage therapy session?

Have you experienced any recent injuries, surgeries, and / or medical conditions?

Are you currently taking any medications or have any allergies?

Please read & understand the following about MoonRoot Wellness:

This establishment holds themselves to the highest standards of an ethical, boundary-driven practice.
Massage is entirely therapeutic and non-sexual in nature.
MoonRoot Wellness has a ZERO TOLERANCE policy for solicitations of any kind, jokes, innuendos, and inappropriate requests are taken seriously, reported, and will result in a swift termination of the session and without a refund.

Please sign if you have read MoonRoot's ZERO TOLERANCE policy for inappropriate behavior:

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