Kundala Massage & Bodywork
Client Intake Form

1. Client First and Last Name

2. Date

4. Which massage modalities have you experienced and found beneficial, or are you familiar with?

5. Could you please share your goals or objectives for this massage session?

Trance, Flow State, Meditation

Overall Muscle Relaxation and Tension Alleviation

Address specific muscle groups that need focus / pain management

Emotional discomfort / Stress Alleviation

Empowered Self Confidence & Self Compassion

Holistic Enrichment and a Boost of Well-Being through Flow Art Therapy.

Enhanced Spiritual Alignment

My primary love language is physical touch, and I recognize the need for more of it to enhance my well-being

Other

If other, please specify

6. If applicable, please identify any specific areas of pain or discomfort that you would like us to focus on during your session. Please note that while we are skilled massage therapists, we are not medical professionals and cannot provide medical advice or address issues beyond the scope of massage therapy. For all questions and concerns outside massage please refer to your physician.

Specific muscle or area? Please describe

If other, please list

10. Does your pressure preference vary? Example: "Deeper in my upper back, lighter on my calves."

11. Draping: We call our drape a "Kundaloin" which can be described as a handmade piece you step into, that securely covers private areas while leaving everything else accessible. This minimal draping allows the Artist to move smoothly between muscle groups. Your Artist will demonstrate how to put it on. Multiple layers of towels are also used on the front for additional privacy. Individuals who identify as female will be covered with a towel on their chest, in addition to their provided coverings. Please check the box to the left indicating you understand.

13. Please inform us of any skin conditions, such as active warts, athlete's foot, or ringworm, so we can appropriately avoid those areas during the massage. Additionally, kindly list any past or current injuries that may affect your session.

14. Do you have any sensitivities or alergies we should be aware of? Are you sensitve to any particular aromatherpies? We primarily use Lavender and Eucalyptus. Please let us know if either of these are problematic.

Our staff will review this form with you and provide further explanation of the content outlined below. After discussing each section, the artist will check the corresponding boxes to confirm your understanding. Finally, we will ask you to sign at the bottom.

Please do not hit the submit button.

Kundala Massage & Bodywork is honored to be a platform for massage therapy licensure by providing massage therapy apprenticeships certified through the State of Utah. Artists Miraj, Scarlet, Taylor, and Jack Jack are such apprentices currently enrolled in our certification and apprenticeship program. We are proud to support their journey toward becoming licensed professionals, and we appreciate your involvement in their development.

Custom Massage: If this massage is boooked, you can expect a relaxing, traditional massage with the classic music, structure and techniques used in swedish and deep tissue massage.

Kundala Massage: When you book a Kundala Massage, you can anticipate a fluid, rhythmic style of bodywork that harmonizes touch with movement to create a therapeutic and immersive experience. This approach is designed to guide you into a trance-like state we refer to as 'Kundaland.' The Kundala Massage unfolds in three distinct waves: 1. **First Wave**: The artist remains grounded, delivering a Kundala-styled Swedish massage to establish a foundation and understanding of the unique techniques and energy being used. 2. **Second Wave**: The artist joins you on the table, incorporating their legs alongside their arms while you are lying face down, enhancing the depth and complexity of the massage. 3. **Third Wave**: The artist utilizes both their legs and arms throughout the entire massage, as you lie face down and face up, providing a comprehensive and dynamic experience. Each wave is thoughtfully crafted to elevate your holistic well-being and guide you to a state of profound relaxation and connection. For yours and the artsits comfort, you cannot skip the first or second wave. This is a time tested process that has been thougtfully created to ensure its effectiveness and quality both for you and the artsit.

The why / science behind Kundala Massage. In a Kundala Massage, we facilitate a process known as 'entrainment,' a scientific concept where one frequency influences another to synchronize with it. Our artists use music to guide their own frequency, which, through entrainment, aligns the recipient with the artist's flow state. This shared flow enhances the holistic experience. We incorporate multiple points of contact to engage the principles of 'polyvagal theory,' which suggests that such contact fosters a sense of nurturing, calm, and well-being. One specific technique we employ is called 'Angel's Landing,' where the artist gently applies their full body weight, akin to a comforting, heavy blanket. These techniques are crafted to induce a trance-like state we refer to as 'Kundaland,' where the release of oxytocin—a hormone associated with love and bonding—enhances feelings of connection and well-being. The therapeutic methods used in a Kundala Massage contribute to its truly transformative and magical experience.

Music: The music selected for a Kundala Massage is more upbeat than traditional spa music, featuring rhythmic tones that serve as a medium for the Artist's flow and are a distinctive element of each session. We utilize an extensive library of songs, some of which may include adult language or themes. Please note that all music is chosen solely to enhance the artistic quality of the massage and should not be interpreted in any other context.

Whenever touch is synchronized with music, it naturally introduces a sensual element. While the touch may feel sensous at times, it is an integral part of the artistry and the performative energy of the massage, and it is never sexual in nature. We maintain the highest ethical standards throughout the entire service and do not tolerate any inappropriate behavior. Your comfort and respect are our top priorities.

Client Etiquette Guidelines: At Kundala Massage, we regard our services as an art form deserving of respect and appreciation. As a client, you agree to refrain from touching the Artist or engaging in any provocative behavior. Such actions are not only distracting to the Artist but also violate our company policy. Any breach of this policy may result in a warning, termination of the appointment, and suspension of future bookings. To fully enjoy your experience, please keep your hands and body relaxed at all times, except when adjusting for comfort.

If you become aroused during your Kundala Massage, please know that this is a natural physiological response and nothing to be ashamed of. At Kundala Massage, we understand that this can occur even in traditional massage settings. Our draping method; the Kundaloin with a weighted towel; will ensure your comfort and privacy. So relax and allow your experience to flow naturally, without concern, knowing our focus will always remain on providing a professional and respectful experience.

During our massage services, the Artists utilize a generous amount of unscented massage oil. As oil can be challenging to remove from fabrics, you may notice some residue on the sheets. Rest assured, all linens are meticulously cleaned to maintain the highest standards of hygiene.

Communication: As a client, you agree to inform the Artist if you are in pain or uncomfortable at any point during the massage, so the Artist can make proper adjustments.

Disclaimer
By signing below, you confirm that you have read and fully understand the contents of this form. You affirm that the information you have provided is accurate to the best of your knowledge and agree to all terms and conditions outlined herein. You acknowledge the inherent risks associated with receiving a massage and release Kundala Massage and its employees from liability for any resulting issues. Furthermore, you understand that failure to disclose any relevant information may negatively affect the quality of the massage. You confirm that you have been thoroughly informed about the style of massage you have booked and voluntarily consent to proceed with the service. Additionally, you agree to communicate any concerns or discomfort to your artist during the massage, allowing for any necessary adjustments or discontinuation of the service.

Client Signature

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Kundala Massage & Bodywork

Kundala Massage & Bodywork
Client Intake Form

Kundala Massage & Bodywork

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Kundala Massage & Bodywork

Kundala Massage & Bodywork Client Intake Form

Kundala Massage & Bodywork

Contact

Address

Hours

Social

Kundala Massage & Bodywork
Client Intake Form