Pre-Massage Consultation Form | Move Pause Restore

Pre-Massage Consultation
Please complete this before your appointment.

Your Details

First name

Last name

Phone

Your Body

Is there anything going on in your body at the moment that would be helpful for me to know?

Are there any areas you’d prefer I avoid or be especially mindful of?

Your Health

Are you currently under medical care or taking medication that may be relevant to massage?

Yes

If yes briefly explain below

Do any current conditions apply that may affect massage?

Yes

recent injury/surgery, fever, unexplained itching or rash/es, skin conditions, heart/circulation, allergies/sensitivities

If yes briefly explain below

What would you like most from this session?

I agree to the cancellation policy.

Cancellations made more than 24 hours before the booking - No charge. Less than 24hrs notice - Up to 50% charged. No shows will be charged at 100%.

I confirm the information above is accurate and I’m happy to proceed with massage therapy.