Intake Form

    Emergency Contact
    Medical Information
    Check all that apply. If you select "yes" to any of the following questions, please explain in the comments section below.
    Massage Preferences
    On a scale from 1–10, how much pressure do you prefer during in both Swedish and Deep Tissue massages?
    Informed Consent
    Please take a moment to carefully read the following: 
    The above information is accurate to the best of my knowledge and I freely give my permission to be massaged. Since massage is contraindicated for some serious medical conditions,it may be necessary to obtain a doctor’s release or prescription before beginning therapy. I agree to inform the therapist of any experience of pain during the session. I understand that massage therapy should not be construed as a substitute for medical examination, diagnosis, and treatment, and that I should see a medical or chiropractic physician or other healthcare specialist. I agree to update the massage therapist in regard to changes in my health and understand that there shall be no liability on the therapist’s part should I forget to do so. 
    Cancellation Policy
    If for any reason you have to cancel, please give us 24 hours' notice.
    Rescheduling or canceling less than 24 hours before your appointment time (or a no show) will result in a charge of $30  for a 1/2-hour or 1-hour massage (per person), $45 for a 1.5-hour massage, and $60 for a 2-hour massage. This charge will be made to your credit card or gift certificate.

    By submitting below I agree to the above terms and consent.
704.749.8101
10:00am – 8:00pm   Monday – Friday
  8:00am – 6:30pm   Saturday
10:00am – 6:30pm   Sunday
2115 Southend Dr. #101
Charlotte, NC 28203
Parking
We have street parking, a parking lot and a parking deck the you can use at any time.
704 749 8101
​2115 Southend Dr #101
Charlotte, NC 28203 
10am – 8:00pm   Monday – Friday
  8am – 6:30pm   Saturday
10am – 8:00pm   Sunday
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Cancellation & Rescheduling Policy
To cancel or reschedule, please call us at least 24 hours before your appointment: 704.749.8101
A no-show, cancellation, or rescheduling less than 24 hours before your appointment time will result in a charge of $30  for a 1/2-hour or 1-hour massage (per person), $45 for a 1.5-hour massage, and $60 for a 2-hour massage. This charge will be made to your credit card or gift certificate. During our high-volume months of December, February, and May, cancellation fee is full price of your session. To read our full policies, please click here.
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