Client Preferences Form
In order to tailor the environment of the massage session to each individual,
I highly encourage all clients to submit preference forms before their appointment.
We can always make adjustments at any time before or during your session
to fit your preferences at the time treatments takes place.

Return to forms page Book Appointment Return to home page

Full Name Session date Email

Room Temperature

Would you like any of the following to assist in achieving your preferred temperature?

Any None Table Heating Pad Heated Blanket Fan Space Heater Extra blankets

Lubricant Scented/Aromatherapy Non-Scented

Room Scents Relaxing (ie: lavender) Energizing (ie: citrus) None

Please note any known allergies to the following ingredients listed below:

Liquidity Lotion
Purified water, isopropyl palmitate (coconut oil derrived), coconut oil, vegetable based emusifying wax NF, sweet almond oil, shea butter, grapeseed oil, macadamia nut oil, tocopherol acetate (Vitamin E), diazolidinyl urea and iodopropynyl butylcarbamate (gentle preservatives). Cruelty Free.

Muse Versatility Creme
Contains: Purified water, isopropyl palmitate (coconut oil derrived) , coconut oil, vegetable based emusifying wax NF, sweet almond oil, shea butter, grapeseed oil, macadamia nut oil, tocopherol acetate (Vitamin E) , diazolidinyl urea and iodopropynyl butylcarbamate (gentle preservatives). Cruelty Free.

Coconut Oil Supreme
Contains: coconut oil

Jojoba Oil
liquid wax extracted from the fruit of the Jojoba plant. Jojoba seeds contain alpha delta and gamma tocopherols and all forms of vitamin E.

Draping
(not applicable to clothed table massage)

I prefer to be covered in the following manner

Pressure Light Light to Medium Medium to Deep Deep Tissue (Ashiatsu Recommended)

Music Selection

Option 1: Genre or Particular Artist (for iPod selection)

Option 2: iPod (several genres, artists and many relaxing massage music playlists to choose from.
Examples of modern music include: Norah Jones, Pink Floyd, U2, Cold Play, Sting and many more!)

Option 3: Other (please select from below)
no music I will bring my own music CD I will choose upon arrival

Option 4: Sirius Radio Reception is based on satellite positions in your area.
Channel (See below for selection options.)
channel 73 (spa) is recommended for traditional massage music

Music Volume very low low medium/audible higher

CHANNELS	NAME	GENRE	DESCRIPTION
01	SIRIUS Hits 1	Pop	Top 40 Hits
02	Starlite	Pop	Lite Pop
03	SIRIUS Love	Pop	Love Songs
04	Movin� Easy	Pop	Easy Listening
05	SIRIUS Gold	Pop	The �50s
06	�60s Vibrations	Pop	The �60s
07	Totally �70s	Pop	The �70s
08	Big �80s	Pop	Your favorite �80s Music
09	The Pulse	Pop	The �90s & Now
10	The Bridge	Pop	Mellow Rock
11	BBC Radio 1	Pop	New Music from the U.K.
12	Super Shuffle	Pop	SIRIUS Super Mix
13	Elvis Radio	Pop	All Elvis Presley, All the Time
14	Classic Vinyl	Rock	Early Classic Rock
15	Classic Rewind	Rock	Later Classic Rock
16	The Vault	Rock	Deeper Classic Rock
17	Jam_ON	Rock	Jam Bands
18	The Spectrum	Rock	Adult Album Rock
19	Buzzsaw	Rock	Classic Hard Rock
20	Octane	Rock	Pure Hard Rock
21	Alt Nation	Rock	Alternative Rock
22	First Wave	Rock	Classic Alternative
23	Hair Nation	Rock	�80s Hair Bands
24	SIRIUS Disorder	Rock	Eclectic/Free Form
25	Underground Garage	Rock	Garage Rock
26	Left Of Center	Rock	New/College/Indie Rock
27	Hard Attack	Rock	Heavy Metal
28	Faction	Rock	Punk, Hip-Hop, Hard Rock Mix
30	The Coffee House	Rock	Acoustic Coffee House Music
31	Radio Margaritaville	Rock	Escape to Margaritaville
32	Reggae Rhythms	Rock	Reggae
33	Area 33	Electronic & Dance	Trance & Progressive House
34	Boombox	Electronic & Dance	Beats/Old Skool
35	Chill	Electronic & Dance	Smooth Electronic
36	The Beat	Electronic & Dance	Dance Hits
37	The Strobe	Electronic & Dance	Disco/Classic Dance
40	Hip-Hop Nation	Hip-Hop/R&B	Nonstop Hip-Hop 24/7
43	Backspin	Hip-Hop/R&B	Old Skool Rap
45	Shade 45	Hip-Hop/R&B	Shady�s Uncut Hip-Hop
50	Hot Jamz	Hip-Hop/R&B	Hip-Hop/R&B Hits
51	Heart & Soul	Hip-Hop/R&B	R&B Hits
53	Soul Town	Hip-Hop/R&B	Classic Soul
60	New Country	Country	Today�s Country Hits
61	Prime Country	Country	�80s & �90s Country Hits
62	The Roadhouse	Country	Classic Country
63	Outlaw Country	Country	Outlaw Country
65	Bluegrass	Country	Bluegrass
66	Spirit	Christian	Christian Hits
67	Revolution	Christian	Christian Rock
68	Praise	Christian	Gospel
70	Planet Jazz	Jazz & Blues	Contemporary Jazz
71	Jazz Caf�	Jazz & Blues	Smooth Jazz
72	Pure Jazz	Jazz & Blues	Classical Jazz
73	Spa 73	Jazz & Blues	New Age
74	SIRIUS Blues	Jazz & Blues	Blues
75	Standard Time	Standards	Standards/Swing
77	Broadway�s Best	Standards	Broadway Show Music
80	Symphony Hall	Classical	Symphonic & Chamber Music
85	Classical Voices	Classical	Classical Voices
86	SIRIUS Pops	Classical	Classical Pops
90	Universo Latino	Latin & International	Latin Pop Mix
92	Rumb�n	Latin & International	Tropical/Reggaeton
93	Bande � Part	Latin & International	New French-language Music
94	CBC Radio 3	Latin & International	Canadian Indie Music
95	Iceberg Radio	Latin & International	Canadian Adult Altervative

Please note any additional preferences/requests for your session below

Please note any additional preferences/requests
for your session below