Massage form | MY BIO MONDE

To offer you the best and unique MY BIO MONDE experience, and send you exclusive informations specially for your needs, please complete this form.

Note this form is intimate for real intimate results, so thank to complete by yourself and not by an assistant.

(I ensure confidentiality of your informations.)

Emilie, Founder MY BIO MONDE (Luxury Beauty Booking)

How often do you get massaged?

Regularly 1or 2 /month

Sometimes 1/season

1 or 2 / year

Never, it's my 1st time

How do you feel physically on 10 today?

How do you feel mentally on 10 today?

How many stress are you on 10 at the moment? (10 =highest stress)

Where are from your stress?

Where are your tensions?

What do you do for your tensions and your stress? Have you got result?

Can you explain me the best massage you received in you life and what you would love to receive today? What it's important for you? Part you love?

Is it easy to let go for you?

Is it some body part you don't want massage?

Treatments? Surgery? Disease?

Appointment date

Jour

Mois

Année

Name

FAMILY Name

Phone

E‑mail

Birthday

Thank you. Emilie +336.06.804.888