Studio of Solace | Client Forms

Thank you for choosing Studio of Solace. This form helps create a safe, personalized session based on your health history, goals, and current needs. All information is confidential.

Personal Information

Name*

Date of Birth*

Age

Preferred Name

Phone*

Email*

Address

City

State

Zip

Emergency Contact

Emergency Contact*

Relationship

Phone*

Reason for Visit

What brings you in today?

Current Symptoms

Pain Assessment

Where are you experiencing discomfort?

How long has this been occurring?

What makes it better?

What makes it worse?

Medical History

Have you ever been diagnosed with any of the following?

Please explain any checked items:

Medications

Please list all medications, supplements, or herbs you currently take.

Allergies

Pregnancy

Are you currently pregnant?

YesNo

Are you under the care of a healthcare provider?

YesNo

Lifestyle

How many hours of sleep do you average each night?

Exercise:

Rarely1-2 days/week3-4 days/week5+ days/week

Water intake:

LowModerateHigh

Session Preferences

Pressure Preference

LightMediumFirmI'll let you guide the session

Areas you would like extra attention:

Areas you prefer not to be worked on:

Are you comfortable with quiet during the session?

YesI prefer occasional check-insI enjoy conversation

Your Confirmation

I have completed this form honestly and to the best of my knowledge.*

Type your full name*

Date

Ticking the box and typing your name is your signature on this health history.