top of page

Client Consultation Form

Before your first session, please take a few minutes to share a little about your wellbeing. Your responses are completely confidential and help ensure your treatment is safe and supportive. Your wellbeing comes first. Some health conditions and medications can change how your body responds to massage, hot stone therapy, stretching, and lymphatic work. Having this information prior to the session helps us choose what’s safe, what needs adjustment, and when it’s better to wait.

Section Title

Health declaration

Please fill out the following form.

Date of birth
Day
Month
Year
Have you been hospitalised in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes
Are you currently taking any of the following medication?
Blood Thinners
Steroids
Painkillers
Autoimmune / Immune Suppressants
Anxiety, depression, emotional wellbeing medication
No - None of the above
Yes but not listed above
bottom of page