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Medical Questionnaire

Prior to your first massage session with Jariya at Thai Massage Greenock we ask you to complete the following medical questionnaire.

We do this so that we have all the information we need to help you get the most out of your time with us.

Please answer as fully as you can. If you need any help with any of the questions please contact us here.

Privacy: the medical information on this form is special-category data under UK GDPR. We process it only to assess whether massage is appropriate for you and to deliver your treatment safely — see our Privacy Notice for full detail.

Your details

Name * Email *

Address * Post Code *

Phone * How Did You Hear About Us * Occupation

About you

Have You Received Massage Therapy Before? * Yes No

If yes, details

Do You Exercise? * Your Age * What Are You Looking To Achieve? *

Medical history

Please tick any conditions or injuries that apply to you. Leave blank if none apply.

Diabetes High Blood Pressure Low Blood Pressure Heart Condition Kidney Condition Liver Condition Recent Surgery Headaches/Migraines Nerve Pain/Damage Neck/Spine Injury Sports Injury Bruises/Abrasions Acute Pain Osteoporosis Blood Clot Varicose Veins Infections Cold/Flu

Any other conditions or injuries we should be aware of Any areas of your body we should not massage

Consent & signature I consent to Thai Massage Greenock processing the medical information on this form to assess whether massage is appropriate for me and to deliver my treatments safely. I understand my rights as set out in the Privacy Notice. *

Client's Signature (type your name in full) * Date *

Address

Thai Massage Greenock
0/2 16 South Street
Greenock, PA16 8UE

Phone

Email

[email protected]

Website

thaimassagegreenock.co.uk

Get In Touch

Full Name *

Phone *

Email

Message *

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Jariya Malone, trading as Thai Massage Greenock · 0/2 16 South Street, Greenock PA16 8UE · Legal Information ·

© 2026 Thai Massage Greenock

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