Client Intake Form
Required fields (*) must be completed.
Name
*
First Name
Last Name
Phone Number
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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)
*
60-Minute Myotherapy/Remedial Massage Therapy $100 (Health fund rebate on the spot)
90-Minute Myotherapy/Remedial Massage Therapy $140 (Health fund rebate on the spot)
60-Minute Deep Tissue/Relaxation Massage Therapy $90
90-Minute Deep Tissue/Relaxation Body+Foot Massage Therapies $130
60-Minute Manual Lymphatic Drainage Massage Therapy $100
90-Minute 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-Minute Deep Tissue/Relaxation Massage Therapy X 5+1 $450
90-Minute Deep Tissue/Relaxation Body+Foot Massage Therapies X 5+1 $650
60-Minute Manual Lymphatic Drainage Massage Therapy X 5+1 $500
90-Minute 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.
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YES, I fully understand
Are you currently taking any medications or managing any chronic health conditions that we should be aware of ?
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Yes
No
If YES, please specify
Have you undergone any surgery within the past 12 months? If yes, we need you to provide a doctor’s clearance letter below
*
Yes
No
Please upload a doctor’s clearance letter here
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Are you currently pregnant ?
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No
I confirm that the information I have provided is true and complete to the best of my knowledge.
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ALL SEASONS NATURAL THERAPY
13 Felstead Avenue, Sunshine West, VIC. 3020 (Phones 0449 539 495 / 0449 532 273)
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