Medical Questionnaire

Name

Address

Post Code

Mobile

How Did You Hear About Us

Occupation

Have You Received Massage Therapy Before?

Yes No

If yes details..

Do You Exercise?

Date Of Birth

What Are You Looking To Achieve From Your Session?

Please tick any of the following conditions that you have

Any other conditions or injuries we shd be aware of

Any areas of your body we should not massage

I understand massage therapy is for stress reduction, relief from muscular tension or spasms, or for increasing circulation. I understand the massage therapist does not diagnose illness disease or any other physical or mental disorder. Massage therapist does not prescribe medical treatment or perform spinal manipulations. I will inform the therapist of any current conditions at the time of each visit. I understand that any inappropriate activity or advances towards the massage therapist Will be reported to the authorities immediately.

Client's Signature (Type your name in full if completed online)

Date

Call Now: 01475 600868

Medical Questionnaire

Thai Massage Newsletter