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Discomfort Diagram

Discomfort Diagram

Many people feel uncomfortable communicating with the therapist, or asking the therapist to do things differently during a massage.  Remember, it is YOUR experience.  Feedback from you during your session will help to make it the best possible experience for you.  Ask if you would like more or less pressure, if you want to focus on or skip particular areas as the massage progresses.  What you thought you needed when you came in may change during the massage as you feel where the tension is in your body.  Every body is different and it is impossible for one technique, style or pressure to work for everyone.  Only you know your body and can communicate how it feels.

PLEASE COMPLETE THIS FORM THE SAME DAY AS YOUR APPOINTMENT

What would you like to address?

What would you like to address?

  • Pain management
  • Injury rehabilitation
  • Stress management
  • Anxiety reduction
  • Relaxation
  • Anti-aging
  • Other (please specify)


What is your current overall physical comfort level?

What is your current overall physical comfort level?

Please indicate how comfortable you are in your body.  A "0" is completely comfortable, a "10" is as uncomfortable as you can imagine.

Shade in the areas where you are tight, sore or painful

Shade in the areas where you are tight, sore or painful




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