Nebraska City's Premier Health & Fitness Center


                                   Massage Therapy Intake Form 

Information is sent directly to Jodie Kreifels ( please call Jodie @ 402-670-0707) 

*All Massages must be paid for at the Front Desk of Ambassador Wellness Center, at the time of service. 

The following information will be used to plan safe and effective massage sessions.

*Note: Clients under the age of 18 must be accompanied by a parent or legal guardian during the entire session.