Client Massage Pre-treatment Form
This confidential form is necessary for us to ensure the treatment we provide is suitable for you and allows us to tailor the treatment to your specific needs. We may want to discuss some of your answers below with you during treatment to help us better understand your condition or how we may adapt the treatment for you. The details below are completely confidential and we will not share your details below with anyone else without your consent.
Email address *
Covid19 Policy
If you are experiencing any of the following please contact us to POSTPONE your appointment for at least TWO WEEKS after you are better:


If you have been in contact with anyone who has had the above symptoms or has been confirmed with Covid19, please postpone your appointment for 2 weeks.
There are no penalties for postponement of appointments.

We advise clients to wear a mask for their appointment and to come alone. Please arrive on time and no more than 5 minutes early. Please bring your own water.

For further information on how we are keeping you safe please see our website-
I have read and understood the Covid19 policy outlined above and will adhere to the conditions above for my appointment. *
Name *
Date of birth *
Mobile phone number *
Doctors name and contact details *
Primary reason for treatment
Clear selection
Health History- Please tick any conditions you are currently suffering from or have a history of.
If you ticked any of the boxes above, please use this space to expand futher- details of any medication, areas of discomfort or pain, details of any injuries or surgery, details of any restrictions of movement.
Please add below any requirements you have for the treatment including pressure preference and areas to focus on.
In completing this form above, I agree to my treatment and have disclosed any medical information that may be affected. *
Many thanks for completing this form. If you have any qustions you can contact us on
We look forward to seeing you for your appointment.
A copy of your responses will be emailed to the address you provided.
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