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Empowering Your Wellness Journey,

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Client Consultation Form

Please complete the form below to help us understand you better.

First name

Last name

Email

Date of Birth

Occupation

When was your last massage treatment? (if applicable)

Have you been hospitalised in the last 12 months? *

No

Yes

Are you suffering from a medical condition, illness, or injury that may impact your massage treatment? *

No

Yes

If you answered yes to any question, please elaborate

Are you in good enough health to have massage treatment? *

No

Yes

If you answered no, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

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Tel: +44 7944 826 133

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