Blissful Membership Lounge Member Wellness Update & Session Customization Form

Member Name: ________________________________

Date: _________________________

Since Your Last Visit:

• Increased Stress or Tension Headaches or Migraines

• Difficulty Sleeping

• Increased Physical Activity Injury or Pain Changes

• Medication Changes

• Increased Swelling or Fluid Retention

• Skin Sensitivities

• Pregnancy Changes

• No Significant Changes

• Other: ____________________

Areas Needing Attention Today

• Neck

• Shoulders

• Upper Back

• Mid Back

• Lower Back

• Hips

• Glutes

• Legs

• Feet

• Arms & Hands

• Full Body Wellness

• Other: ____________________

Wellness Goals For Today's Session

• Relaxation

• Stress Relief

• Pain Relief

• Improved Mobility

• Better Sleep

• Athletic Recovery

• Lymphatic Support

• Self-Care Maintenance

• Mental Clarity

• Overall Wellness

• Other: ____________________

Complimentary Monthly Member Enhancement (Choose One)

• Warm Stone Back Therapy

• Reiki

• Gua Sha

• None This Visit

Additional Member Enhancements ($25 Each)

• Aromatherapy Ritual Enhancement

• CBD Enhancement

• Sound Therapy

• Hand Renewal Polish

• Foot Renewal Polish

• Mini Foot Reflexology

• Lymphatic Facial Massage

• Cupping Therapy

• Craniosacral Therapy

Aromatherapy Preference (Optional)

• Rest

• Relax

• Rejuvenate

• Bliss

• Therapist Recommendation

Notes For Your Therapist

_________________________________________________________ _________________________________________________________

__________________________________________________________________________________________________________________