Antonina Bodywork

Intake Form

Please note that a vaccination against the COVID-19 virus is required to receive treatment. By signing the intake form, you are verifying that you have received either a WHO-approved or FDA-approved vaccine.

The intake form is an Adobe Acrobat PDF form. If you are able to complete it before your visit, we can start your session as soon as you walk in the door. You can either fill out the form by hand, or fill it out on your computer.

If filling the form out on your computer, **Please note** that information will not be saved if entered via your browser window. The form will not save your information unless it is downloaded to your computer first.

If you enter data via the browser window, you will (unfortunately) have to re-enter the information.

The form can be sent to antoninabodywork (at) gmail (dot) com.

Click here to download the intake form.

Adobe Acrobat Reader can be downloaded here. The Preview application on a Macintosh will also work, as will most other generic text-writing applications.

 

 

Antonina Bodywork offers structural-style, deep-tissue therapeutic bodywork and sports massage. Located in Central Square, Cambridge MA.