Member Registration

I am interested in becoming a(n) *

Individual Member
Partner Member

For my *

Workplace Wellness Program
Social Network

Company Name *

Network Name *

Your Name *

First

Last

Email *

Phone Number *

Password *

Password

Confirm Password

Birth Date *

Emergency Contact *

First

Last

Phone

Though we do not hope for or anticipate incidents to occur during a session, it is important for us to have record of who to contact in case of an emergency. Learn more

I am authorized to schedule wellness sessions on behalf of the above mentioned company/network.

Who referred you to the AIM Wellness Membership program?

Primary Session Location *

Any parking or location notes we should be aware of? Choose all that apply. *

Is there a $ parking fee? *

What is the $ parking fee? *

What animals/pets should we be aware of? *

How many stairs/flights are required? *

What other parking/location notes should we be aware of? *

What best describes your workplace wellness goals? Choose all that apply. *

What other workplace wellness goals do you have? *

What best describes your social network wellness goals? Choose all that apply. *

What other social network wellness goals do you have? *

How many people part of your company are to receive wellness treatments from AIM? *

Cannot exceed 50

How many people part of your network are to receive wellness treatments from AIM? *

Cannot exceed 50

“I am hopeful AIM Massage Therapy can help me with the following wellness goals.” Choose all that apply.

What areas would you like targeted? Choose all that apply. *

What other wellness goals do you have? *

Do you have any known allergies to oils, lotions or ointments? *

What oil, lotion or ointment allergies do you have? *

Any health conditions we should be aware of? Choose all that apply / "None" if N/A. *

Refer to our Contraindications and Areas of Caution documentation prior to scheduling.

What health conditions should we be aware of? *

If applicable, list medications currently being taken to treat condition(s).

It is important that you inform your Therapist of any medications you are taking, as the effects of some medicines may become counterproductive to treatment. Learn more

Please note that a Health and Safety Liability Form will be issued before each session and will require signature.

I certify that I am at least 18 years old and that I read, understand and agree to AIM’s Terms and Conditions.

Servicing the New York City and New Jersey areas © 2026 Abide In Me Therapeutic Massage Services

Servicing the New York City and New Jersey areas

© 2026 Abide In Me Therapeutic Massage Services