I Aspire

Name *

First Name

Last Name

PhoneNumber *

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Please select any conditions that apply *

If you have selected any of the following a waiver from your Pregnancy Facilitator (Doctor, Dula, Midwife) must be received by my office before I can preform any massage.

Bleeding

Pre-term contractions

High-risk pregnancy

Pregnancy-induced hypertension (PIH)

Preeclampsia

Previous pre-term labor

Experiencing severe swelling

high blood pressure

Sudden/severe headaches

Recently gave birth

None of the above

Seeking Relief from Prenatal Related Issues *

Select any that apply for this session today

Reduced Back pain

Reduce Sciatic pain

Reduced Joint pain

Improved Circulation

Reduced Edema & Swelling

Reduced muscle tension

Reduce headaches

Reduced stress and anxiety

Improved oxygenation of soft tissues and muscles

Better sleep

Hormone Balance/Regulation

Just to Relax

Other