BOOK CONSULTATION | Massage Magic

MASSAGE CONSULTATION FORM

Please complete this short form before your first treatment. If you answer "yes" to any question, use the notes box to give a few details this helps us keep your session safe and comfortable.

Personal Details

Name

Date of Birth

Day

Month

Year

Phone Number

Emergency Contact Name & Number

Address

Health Screening

Any notable injuries, operations, or illness now or in the past 12 months? Y/N

Any allergies? Y/N

Any body areas to avoid? Y/N

Are you on any medication? Y/N

Do you have any health conditions we should know about? Y/N

Have you recently consumed alcohol or unprescribed drugs? Y/N

Female only: could you be pregnant? Y/N

What is your approximate height and weight (for best room setup)

Anything else to note?

Declaration

I will treat the therapist with 100% respect at all times.

I agree to the zero tolerance policy on unacceptable behaviour or language.

I agree to this information being stored in accordance with the 2018 Data Protection Act.

I have told the truth above, and release the practitioner from responsibility for anything that may result from me not disclosing the relevant information.

Signature

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Date of appointment

Day

Month

Year