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Massage Consultation Form
Health Declaration

Please fill out the following form to the best of your knowledge & please ensure that you answer each question as truthfully as you can. By filling in this form it can speed up your check in process on the day of your appointment.

Any known allergies?
Are you currently taking any medication?
Have you had any recent surgery or chemotheraphyin the last 12 months? ( if yes, please specify where )
Have you had a massage treatment before? ( if yes, how long & what massage treatment have you had )
Have you been hospitalized in the last 12 months?
Please tick all that applies to you:
Are you suffering from any injury?
Would you like to receive any marketing from us regarding deals, new services & products including discounts?
If yes, please tick how you would like to receive marketing from us?
Will you be making a claim through your health insurance for this session?

Thanks for submitting!

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