Client Application Form

New Client Application Form

Thank you for your interest in becoming a client at Ease Manual Therapy. Please fill out the following information to help us understand your needs and how we can assist you on your journey to improved health and well-being.


Personal Information



Health Information



At Ease Manual Therapy, we believe in working with our clients as active participants in their health. Are you willing to:


Emergency Contact Information


Consent and Signature

I certify that the information I have provided is accurate to the best of my knowledge, and I consent to receiving massage therapy as part of my healthcare plan. I understand that it is my responsibility to inform the therapist of any changes in my health or medical status.

Once completed, we will contact you to schedule an initial appointment. We look forward to working with you on your journey to a pain-free life!