Home
About Us
About Sandstone
Staff
Policies
Our Services
Therapeutic Services
Facial Services
Membership
Policies
Media
Events
Blog
Careers
Why Choose
Application
Contact
Shop
Book Now
Gift Certificates
Forms
Intake Form
Facial Intake Form
Covid-19 Form
Employment Application Form
(Must be completed by all applicants)
Email
First Name
Email Address
Home Address
Birth Date
Emergency Contact
Last Name
Phone Number
Zip*
Confirmation Preference
Text
Email
Phone Call
How did you hear about us?
Another Client
Doctor
Event
Facebook
Google
Local Business
Next to CVS
Physical Therapy
Yelp
If another client, Business, or other, please specify
Have you ever had a professional massage?
Yes
No
If yes, when and where?
What specific areas would you like your therapist to concentrate on?
[anatomy]
Are there any areas you do NOT want massaged?
Yes
No
If yes, please list:
What are your goals at Sandstone? (choose all that apply)
Relaxation & Swedish Massage
Focused Therapeutic Massage
Pain/Injury Rehabilitation
Facials & Skin Care
Holistic Therapies
Nutrition & Wellness Consultations
On a scale from 1-10 are you experiencing any pain today?
1
2
3
4
5
6
7
8
9
10
Is this visit due to the following?
Birthday
Car Accident
Celebration
General Pain
Gift Certificate
Personal Injury
Stress
Workers Comp Injury
Other
Health History ( select all that apply)
Anxiety
Arthritis
Artificial Joints
Autoimmune Disease(s)
Blood Clots
Blood Thinners
Bruises Easily
Cancer (active/remission)
Circulation Disorder
Depression
Diabetes
Fibromyalgia
Hearing Impaired
Heart Condition
High blood pressure
High Stress
Hypermobility
Jaw Clenching/ Tension
Low Blood Pressure
Migraines/Headaches
Numbness/Tingling
Open Wounds
Seizures
Skin Disorders
Strokes/TIA'S
Swelling
Other
N/A
