Intake Form - James the Rolfer™

Rolfing® Intake Form

Please fill in this form to get the most from your Rolfing sessions.

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Age (not a required field, but it is useful info for me) *

Are you pregnant? (Please let me know if you become pregnant, even if it's early days) *

Yes No (Men please take this option)

Please tell me why you have decided to come for Rolfing. Please include the things you are looking for help with. *

Let me know about your general health. *

If there's anything else that you want to let me know or ask me, use this box. *

Submit

Dear James,
thank you so much for my session yesterday, I went home feeling taller, head held higher, feels good.
I will be making another appointment. I will be in touch soon.
Regards Frances.

I first went to James for a series of 10 sessions a couple of years ago, fantastic. I have had several treatments from him since. His knowledge, focus, attention and passion for his work shines through.
Oh, and he has a great sense of humour, which is very important in life, I find.
Michael Doran-Mental Health Nurse.

Thank you James for fixing my body! I'm looking forward to a pain free back in the mornings (no pressure) I don't know how I end up looking like Frodo Baggins! But you always make me perfect again. Rolfing rawkz! Sheena Curran