Andrea Sutcliffe, 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


Some medical conditions limit what can be done in a Fascia 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!