UPCOMING EVENTS
Physical Wellness for Handcrafters and seated massage at The Yarn Spot in Wheaton, MD. 

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CALENDAR
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SEPTEMBER SPECIALS
Deal Days Are Here!

FIRST TIME CLIENTS
Welcome to Peace at Hand!

CONTACT
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First Time Clients

Welcome to Peace at Hand! We are happy that you have chosen us for your next massage and look forward to working with you. In order to most safely and effectively address your needs, please complete the following form at least 24 hours before your first appointment. All information is confidential. If you prefer not to submit your information digitally, a hard copy of this form is available. Please email us to request that a copy be brought to your appointment.

For more information about what to expect from your massage, please visit our information page. If you have never received a professional massage, The American Massage Therapy Association has a short article about what to expect.

All Fields Required
Name
Address
Occupation
Birthdate
Daytime Phone
Evening Phone
E-mail
Referred by
Have you ever had a massage or other bodywork before? If so, what type and how frequently?
In a few words, please describe your general, physical health
How would you rate your general daily stress level?
Where do you generally feel stress/tension in your body?
What are your goals for your massage session?
Are you presently under a doctor or therapist’s care? If so, what for?
Are you or could you be pregnant? If so, when are you due?
How often do you exercise? What sort of exercise do you do?
Are you currently taking any medications? If so, what are they for?
Do you wear Contact Lenses
Hearing Aides
Dentures
Are you aware of any allergies or sensitivities to oils or scents? If so, what?
Please indicate any of the following that apply to you Carpal Tunnel Syndrome
Tuberculosis
Broken Bones
Arthritis
Circulatory Problems
Cancer
Digestive Problems
Diabetes
Fibromyalgia
Headaches
Heart Disease
High Blood Pressure
HIV/AIDS
Muscle Sprains/Tears
MS
Sleeping Problems
Respiratory Problems
Grind Teeth/TMJ Disorders
Surgeries
Varicose Veins
Allergies
Skin Conditions
Are there any other health/medical/emotional issues that you feel we should know about?
Verification *
Please type the phrase above into the box below