Client Intake Form
Required fields (*) must be completed.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In case of emergency, please provide the name and contact details of the person we should notify.
Book your Appointment (Thursdays Closed)
*
Please choose your treatment:(✓ Tick one)
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60-Minutes Myotherapy/Remedial Massage Therapy $100 (Health fund rebate on the spot)
90-Minutes Myotherapy/Remedial Massage Therapy $140 (Health fund rebate on the spot)
60-Minutes Deep Tissue/Relaxation Massage Therapy $90
90-Minutes Deep Tissue/Relaxation Body+Foot Massage Therapies $130
60-Minutes Manual Lymphatic Drainage Massage Therapy $100
90-Minutes Maderotherapy/Sculpting Massage Therapy $200
II $AVE MORE!! II Special Package Offer II 5 Sessions + 1 Free II (Pay upfront at your first session).
60-Minutes Deep Tissue/Relaxation Massage Therapy X 5+1 $450
90-Minutes Deep Tissue/Relaxation Body+Foot Massage Therapies X 5+1 $650
60-Minutes Manual Lymphatic Drainage Massage Therapy X 5+1 $500
90-Minutes Maderotherapy/Sculpting Massage Therapy X 5+1 $1,000
Please note that this is a professional massage therapy practice focused on health and wellness, and any inappropriate request or behavior will result in immediate termination of service. Thank you for respecting our team, our professionalism, and our trusted reputation.
*
Please Select
YES, I fully understand
Are you currently taking any medications or managing any chronic health conditions that I should be aware of ?
*
Yes
No
If YES, please specify
Have you undergone any surgery within the past 12 months?
*
Yes
No
Are you currently pregnant ?
*
Yes
No
I confirm that the information I have provided is true and complete to the best of my knowledge.
*
ALL SEASONS NATURAL THERAPY
13 Felstead Avenue, Sunshine West, VIC. 3020 (Phone 0449 539 495)
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