Welcome🙏🏻🌒✨Book a treatment by filling in this form

Welcome🙏🏻🌒✨Book a treatment by filling in this form

All information is held confident under the data protection act. At no given point is information disclosed or shared without client’s written consent. 🌟 Please fill out this short 2 page form completely and sign to make a valid booking, Luno 🌒
Today's Date

MonthDayYear
Date
Full Name

First NameLast Name
Are you booking an Incall or Outcall massage?
Birth Date

MonthDayYear
Phone Number
Format: 00000000000.
E-mail
example@example.com
Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Address of the location you wish to be massaged at if booking an Incall Massage (must be in London)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Promo/Discount codes:

Book an Appointment 🌟 Option 1: 60 minutes - £70
🌟 Option 2: 90 minutes - £100
🌟 Option 3: 120 minutes - £130
Medications
Allergies
Please list any injuries you have had.
Are you currently seeing any other healthcare professional?
Client information is confidential under data protection act and written authorization is required to release any information.

Please reschedule session if more than 15 minutes late.

24 hour cancellation notice is required

You will be draped and at no time be exposed.

You may end the session at any time for any reason.

Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law

Client Agreement:

I understand that therapeutic massage therapy does not diagnose and heal illness, disease, any physical or mental disorder.

I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.

I understand that this treatment is designed to address the care and prevention of myofascial pain and dysfunction.

I understand that at any time I feel pain or discomfort during the session, I will immediately inform my therapeutic massage therapist.

I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status.

By my electronic signature below, I agree to the massage policy and client agreement above.
Signature

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