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What is your current level of stress?
 
Extreme
 
High
 
Medium
 
Low
 
 
 
Do you have soreness in any specific area?
 
Yes
 
No
 
 
 
Where is the area of soreness, or area of concern?
 
Neck
 
Back
 
Legs
 
Arms
 
Other
 
 
 
 
Are you interested in facial peels, body treatments, or Laser hair removal?
 
Yes
 
No
 
 
 
Have you ever had a massage before?
 
Yes
 
No
 
 
 
What is your name?
 
-
 
-
 
-
 
-
 
Name:
 
 
 
 
What is your email?
 
-
 
-
 
-
 
-
 
Email:
 
 
 
 
What is your phone number?
 
-
 
-
 
-
 
-
 
Phone#:
 
 
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