Intake Amita Spa Intake Form Personal Information First Name Last Name Phone Email Massage Information Pressure preference Light Pressure Medium Pressure Deep Pressure Other Pressure preference What is your primary reason for having a massage today Relaxation Therapeutic Pregnancy Integrated Bodywork (functional) Other What is your primary reason for having a massage today Are you sensitive or allergic to fragrances or perfumes? Yes No Please specify Are there any areas of your body you'd prefer us to avoid Yes No Please specify Next