New Client Form 2022 - Finding Source

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*Please take the time to fill out this form completely.

- MASK info: For medical reasons Gary does not wear a mask in session and does not require his clients to wear one either. If you choose to wear a mask that is your choice. If this is not acceptable then you may try again another time in the future when you are more comfortable with this policy.

- Availability: Availability is first come first serve. Gary tends to book out about 2+ weeks in advance (longer during peak times) for most new clients depending on how your schedules coincide. Immediate openings are rare so please keep this in mind when requesting an appointment.

- Payment: All New clients without a verifiable referral must prepay for their first session in advance, before you can be scheduled. 'Verifiable' means someone who has been to Gary as a client and can be contacted if needed. For reference New Client pricing is HERE.

New Client Request Form
*Form takes about 3 minutes to complete

* Indicates required field

Name *

First

Last

Email *

Cell Phone Number *

Gary's scheduling software automatically sends out a text reminder prior to your appointment

Your Age *

I have fully read the 'Mask info', 'Availability' & 'Payment' sections at the top of this form and fully understand/consent to these policies *

Yes

Do you have a Gift Certificate or Voucher *

No Finding Source Gift Certificate Other - explain below

(if Applicable) What kind of voucher do you have? *

**For reference, New Client pricing is HERE

If you purchased a Gift Certificate which time option did you buy? or which option do you want? *

1 Hour Session 90 Minute Session 2 Hour Session Other

Full Name of Person who purchased your Gift Certificate or Voucher *

Full name of your Referral if you have one *

Are you Pregnant? *

Yes - *Restricted services only, if eligible No

Gary's massage style is not suited for pregnant women. However Reflexology, can be done beyond the 38/40 week mark on a case by case basis only.

Do you have any Medical conditions/ chronic problems? (Please be specific) *

If No - Type: NONE - If Yes please give a brief description *Example: Bulging Disks lower back, Stiff Neck, Insomnia or Trouble sleeping

What type of session do you want? *

If you are not familiar with Gary's style of work or have specific medical issues then just choose the "Need to Discuss" option

NOTE: Saturday appointments are reserved for regular clientele
- All New Clients must schedule Mon-Fri during posted hours before
being eligible for a Saturday time slot if it becomes available

Monday-Friday: Day & Time frame preferences - Check all that apply *

First Available - Anytime Early - 11am to 2:30pm (Mon-Fri) Afternoon - 2:30pm to 5pm (Mon-Fri

*Note - The more flexibility you have in your schedule will generally get you in sooner.

Please request specific dates/times here: (**Note: Gary does not provide evening appointments) *

Additional requests, comments or questions here: *

Please indicate below if you have purchased or are requesting a Full Consultation.
If you have not yet paid for a Full Consultation, you may do so HERE (choose option #3)

I am requesting this service & understand that I will need to prepay prior to getting scheduled. *

Yes, I am requesting a Full Consultation - please bill me I have already prepaid for a Full Consultation I do not need a Consultation

**NOTE: If you are OPTING IN for a Full Consultation, answer the questions below
If you have OPTED OUT then scroll down to SUBMIT this form by using the BLUE BUTTON at the end of the page

Preliminary Questions for your Consultation:
Please BE SPECIFIC, your answers will be used to prepare information for your session.

1. Do you have a specific goal in mind for your Consultation? (examples: Eliminating chronic pain, Getting off of my medications, etc.) *

2. List all Medications by name that you are on and what they are prescribed for: (example: Lexapro – For Anxiety) *

3. What nutritional supplements do you take? (example: Multi-vitamin/Mineral, Vitamin D, C, Specific herbs etc.) *

4. What does your diet generally consist of? (example: Conventionally grown food, Organic Food, Fast foods? Or combination of all 3?) *

5. Do you have any sleep issues? How often do you wake up fully rested and refreshed? (example: 25% of the time, 50% of the time, 75% of time, etc...) *

6. Do you get at least 4 standard size (16.9 oz) bottles of water everyday? *

7. If you are trying to alleviate any specific issues with your health what are they and are any of these issues debilitating or limit you in any way? *

8. How often do you get massaged, or get alternative treatments such as reflexology, energy healing etc. *

9. List anything else that may be of importance to your consultation here: *

Submit Form

General Info

- Contact Gary
- About Gary
- Gift Certificates

Gary's Services

- Thai Massage
- Thai Reflexology
- Cupping Massage
- Vibrational Tuning
- Axiatonal Integration
- Holistic Counseling

Featured Benefits

- Pain Management
- Pain Elimination
- Self Empowerment
- Self Reliance
- Greater Health & Vitality

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