• Covid Questionnaire & Consultation

    Cotswold Mobile Massage
  • Massage is a close contact service that means we must adhere to strict Covid protocols. Please ensure this form is completed to the best of your ability, sign and submit at the bottom of the page. NB. It is mandatory that forms are received prior to your appointment date in line with new regulations related to Covid-19.
  • Your details

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  • Covid Questionnaire

  • Consultation Form & Medical History

  • Declaration

    By signing below, I declare that the information I have provided is true and correct. I am aware that by making a false declaration or withholding information could result in detriment to my own health and others. I am aware that purposely withholding or falsifying information is a criminal offence. If either I or someone I have been in contact with tests positive for Covid-19 or have been contacted by a tracing app I will inform you without delay.
  • Consent

    By signing below, I consent to receive massage treatment from a Cotswold Mobile Massage therapist.
  • Clear
  • Thank you for taking the time to complete this form. We look forward to treating you soon.
  • Should be Empty:
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