Andrea Sutcliffe, Certified Rolfer: Fascia Bodywork
New Hampshire Structural Integration License #0032

Client Forms

Please take a few minutes to print and complete the following two forms.  Bring the forms with you to your first appointment.

Consent Form

Health Intake Form


Please note the office is on the second floor accessed by stairs only.  If going up or down stairs is a challenge for you, please let me know and I can arrange for an alternate location.

Some medical conditions limit what can be done in an Integrative Bodywork Session.  The following two forms may be necessary only after we have discussed your individual situation.  I may need to get input from your doctor:

Physician's Permission form

Physician's Referral form

Thank you!