Welcome — let's get you settled

A few details before your first session so your therapist can tailor the work to your body and keep you comfortable.

Your details

Full name

Ava Renner

Date of birth

04 / 12 / 1990

Phone

(555) 318-2204

How did you hear about us? — optional

A friend who comes here

Health history

Current conditions or concerns — anything we should know about

Tight shoulders and lower-back tension from desk work; recovering from a mild ankle sprain.

Contraindications — pregnancy, recent surgery, blood clots, skin conditions, etc.

None currently — please note any that apply.

Current medications

None

Allergies / sensitivities

Scented oils

Today's focus

Pain or focus areas — where should your therapist concentrate?

Neck, upper back, and right shoulder. Please ease up around the left ankle.

Pressure preference

Light Medium Firm Deep tissue

Or describe it in your words: Medium overall, firmer on the shoulders

Areas to avoid — optional

Please avoid the abdomen

Consent

Ava Renner

Client signature

June 17, 2026

Date

Stillwater Bodywork · Your information is kept private and confidential.