Get Zen Shiatsu Chicago

Filling out the Zen Shiatsu Chicago client intake form is essential for ensuring personalized and effective bodywork sessions. This guide provides a clear, step-by-step approach to completing the form accurately and efficiently.

Follow the steps to complete the form easily.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Provide your full name and the date at the top of the form. Ensure accuracy to avoid any issues with scheduling.
3. Enter your primary phone number, circling whether it is your home, work, or cell phone. Optionally, include a secondary phone number and specify its type as well.
4. Fill in your email address and indicate if you would like to receive the monthly email newsletter.
5. Complete your address information, including city, state, and zip code, along with your date of birth.
6. Specify how you learned about Zen Shiatsu Chicago to help them improve their outreach efforts.
7. List an emergency contact, providing their name, phone number, and relationship to you.
8. In the section regarding your personal goals or concerns for bodywork, provide thorough details on what brought you to Zen Shiatsu.
9. Describe any previous experiences with bodywork or massage, elaborating on the type and frequency.
10. Outline your general diet, exercise routine, and any medications, herbs, vitamins, or supplements you are currently taking.
11. Disclose any consumption of caffeine, cigarettes, alcohol, or drugs, including the amount if applicable.
12. Note your occupation and any hobbies or activities that are part of your lifestyle.
13. Identify typical areas of tension in your body for the practitioner's reference.
14. Review your medical history by checking all applicable medical conditions. Mention any surgeries, broken bones, or serious injuries from the past three years.
15. Address any additional complaints or medical conditions you think your practitioner should be aware of.
16. Indicate whether you have reason to believe you may be pregnant.
17. Affix your signature on the designated line, or have a parent or guardian sign if you are under 18.
18. Finally, save your changes, then download, print, or share the completed form as needed.

Start your Zen Shiatsu journey by completing your intake form online today.