New Client Intake Form

Welcome! Sharing a little about yourself before your appointment helps Santa, owner of Healing Hands by Santa, tailor the session to what your body actually needs. Please share what you can — nothing here replaces a conversation at the start of your visit.

Privacy note: the information you share here is used only to prepare for your appointment. Please keep details general — avoid sending highly sensitive medical records. For urgent concerns, call or text (949) 449-1842 or email Santa directly. Massage therapy is not a substitute for medical care — if you have an emergency or active medical issue, please contact a qualified healthcare professional.

Full name * Email * Phone * Appointment date/time (or preferred date/time) Are you a new client? Yes — this is my first session No — I've seen Santa before

Areas of focus

Where are you feeling pain, tension, or discomfort? (check all that apply)

Neck / shoulders Upper back Lower back Hips / glutes Legs / feet Arms / hands Headaches / jaw Other

Anything else about those areas you'd like Santa to know? Pain / discomfort level (0 = none, 10 = severe) Select a level 0 — none 1 2 3 4 5 — moderate 6 7 8 9 10 — severe Massage pressure preference Light Medium Firm Not sure — let's decide together Main goal for this session Relaxation Pain relief Mobility Stress relief Recovery Other

Health considerations

Please share anything that could affect your session. Keep it general — you can give Santa more detail in person.

Do any of the following apply? (check all that apply)

Recent injuries Recent surgeries Ongoing medical conditions Pregnant or postpartum Skin sensitivities Allergies (lotions, oils, scents) Areas to avoid

Anything Santa should know in more detail? (optional) Acknowledgment *: I confirm the information I've provided is accurate to the best of my knowledge. I understand that massage therapy is not a substitute for medical care, and I agree to let Santa know about any changes to my health or comfort before and during my session. I agree to receive text messages from Healing Hands by Santa at the mobile number provided above. Messages may include appointment confirmations, reminders, rescheduling notifications, and customer care updates. Message frequency varies. Msg & data rates may apply. Reply HELP for help or STOP to cancel at any time. View our Privacy Policy and SMS Policy. Submit intake form