Outpatient Massage Therapy


Please correct the errors described below.

Thank you for your interest in Healwell Outpatient Massage Therapy. Please complete this form and we will contact you to schedule an appointment as soon as possible.

Patient Information

Medical Must-Knows

The following questions are important to let your therapist know about any medical wishes you may have and what they should do in the case of an emergency. If a question does not apply to you please just skip it.

Please list the person's full name and phone number.

Payment Information

We require a credit card number to reserve your appointment. We will not charge your card until AFTER your massage session.

Emergency Contact Information

Add another emergency contact

Your message will be encrypted and can only be read by Healwell.