Massage Consultation Form

IASOMASSA CONSULTATION FORM

Please complete this consultation form prior to booking to ensure suitability. Failure to do so will result in cancellation & forfeiture of payment. Completing this form is a one-time requirement, unless changes have occurred.
Client’s Full Name*

PrefixFirst NameLast Name
Designated Treatment Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
On-site parking availableNearby parking availableLimited availabilityNo parking availableOther
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
FeverContagious or infectious conditions.Under the influence of recreational drugs or alcohol.Undiagnosed lumps.InflammationCuts, bruises or abrasionsVaricose veinsPregnancyMenstruation (first few days)Haematoma or herniaRecent fracturesSunburnAny conditions affecting the neck.None of the above.
Muscle tension or achesBack discomfortJoint stiffnessHeadaches or migrainesOther
Kindly share any known sensitivities or allergies to ensure the safest & most comfortable treatment.*
Skin profile.
Is this your first Swedish massage?
Please select your primary reason for booking today.
Professional Conduct
Acknowledgement
Confidentiality & Care

Your personal information is held with the utmost confidentiality & used solely to ensure your treatment is safe, effective & uniquely tailored to you.
Authorised Signature*
For security, please confirm that you are human.*
Should be Empty:

IASOMASSA CONSULTATION FORM