Client Consultation Form

Client Consultation Form
Full Name

First NameLast Name
Contact Number

Area CodePhone Number
Date of Birth

DayMonthYear
Email Address
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Check the conditions that apply to you:

Other
What massage pressure do you prefer?
Are you currently taking any medication?
Please list them.
Do you have any allergies?
Please list them.
What would you like to achieve from your treatment?
e.g. Relief from tension, Rehydrate skin etc
During your treatment we may take before and after pictures. Please specify if you are happy for these to be shared on social media and in our emails. Your therapist will always request permission before taking photos.
I have read and understood the questions asked and can confirm that the answers I have given are correct, that I have NOT withheld any information that may be relevant to treatments
Should be Empty: