Two Roads 4 Kids - Pediatric Massage Therapy

Forms to Complete

Before we get started, parents, kindly take a moment to provide me with the following information so that I may maximize the effectiveness and safety of our sessions together. 


All information provided by you will be kept confidential.

You may fax (1.512.233.5361) or snail mail the completed forms to me (11506 Oak Knoll Drive, Austin, Texas 78759).

Pediatric Client Intake Form

If you are a first-time client, please print this form, complete it and bring it with you to your first session.

Parent Consent Form for Pediatric Massage

This form needs to be completed and signed by a parent.

Physician Acknowledgment Letter for Pediatric Massage

This letter needs to be completed and signed by your child's physician.

Note: To download Adobe Acrobat Reader for free, click here.