New Client Special
BOOK NOW
GIFT CARDS
Membership
|
Promotions
|
Contact Us
| |
Insurance
Realign
Deep Tissue
Sports Massage
Yogic Neuromuscular
Massage/Acupuncture Combination
Cupping and Massage Treatment
Acupuncture Facial Rejuvenation
Relax
Swedish Massage
Deep Heat Massage
Aromatherapy
Acupuncture
Energy Work
Craniosacral Work
Shiro
Foot Essentials
Workplace
Therapists
Ai Hua
Alan
Amanda
Ann Claire
Carlos
Carmen
Chris
Darlene
David
Deanna
Gregory
Igor
Jen
John
Luis
Marie
Mariko
Nick
Nirvana
Olga
Rimma
Stefany
Sarah
Yaddy
Home
Intake Form
First Name *
Last Name *
Birthday *
Email *
Exercise Habits *
Please select one
Once a week
2-3 times a week
4+ times a week
Type of Exercise *
Please select one
Weight Training
Aerobic (Run
Spin
Bike)
Pilates
Yoga
Training for Event
Current pain from past injuries?
Yes
No
Injuries
Allergies or Medications
Type of pressure preferred: *
Please select one
Light
Medium
Deep
Areas of Pain *
Head
Neck
Shoulders
Wrist
Upper Back
Lower Back
Hips
Front Leg
Back Leg
Knees
Ankle
Abdominal
How would you rate your overall health today? *
-5
-4
-3
-2
-1
0
+1
+2
+3
+4
+5
Where would you like your health to be? *
-5
-4
-3
-2
-1
0
+1
+2
+3
+4
+5
Areas To Improve
Joint Pain
Inflammation
Sleep
Allergies
Digestive Issues
Muscle Cramping/Pain
Stress Management
Energy Levels
Weight Loss / Healthy Eating
Other
Inner Wellness
Please select one
More mental clarity and organization
More abundance in my life
More love and compassion in my life
How did you hear about us?
Referral
Online Search
Event
Spa Finder
Facebook
Email
Other
Submit
SEE OUR
Last-Minute
Openings!
Click Here
×
MPower Bodywork
32 Union Square East, 6th Floor, Suite 603
New York, NY 10003
212-539-1690
BOOK NOW
×
MPower Bodywork
32 Union Square East, 6th Floor, Suite 603
New York, NY 10003
212-539-1690
GIFT CARD
BACK
×