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Grantley Massage Medical Consent Form
Please ensure you complete this form as thoroughly and honestly as possible at least 72 hours before your appointment.  This will enable me to ensure you are able to proceed with your chosen service. Ian (Grantley Massage )  07758 225 711
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Email *
Full Name *
Address *
Mobile  *
Email address *
Do you have any injuries or complaints at present ? If Yes please indicate: If No, please leave blank: *
Have you had any operations in the last 5 years: If Yes, please indicate and  say which year: Leave blank if No. *
Do You Have any suffered any of the following conditions? *
Required
Do You take Recreational, Natural or Pharmaceutical Medication? If yes please list: *
Do you have any allergies, or are allergic to any essential oils? *
Required
Do any of the following apply to you? *
Required
 By completing and returning this pre massage medical consent form you agree that all the above information is true and correct to the best of your knowledge, and no liability is incurred for health complaints  as a result of a massage . *
A copy of your responses will be emailed to the address you provided.
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