The Massage Consultation Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, and features customizable and printable examples.
Massage Consultation Form Template UK Editable – PrintableSample
Massage Consultation Form Template UK 1. Client Information 2. Emergency Contact Information 3. Health History 4. Current Medications 5. Previous Massage Experience 6. Areas of Concern 7. Preferred Massage Techniques 8. Session Goals 9. Consent and Acknowledgment 10. Cancellation Policy 11. Signature and Date
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Examples
[Client’s Full Name]
[Client’s Address]
[Client’s Phone Number]
[Client’s Email Address]
[Emergency Contact Name]
[Emergency Contact Number]
[Date]
Please list any health conditions, allergies, or existing injuries:
[Details]
Please list any current medications:
[Details]
[Client to specify the reason for seeking massage therapy. E.g., relaxation, pain relief, etc.]
[Client to indicate preferred massage techniques, e.g., Swedish, Deep Tissue, Aromatherapy, etc.]
I, [Client’s Full Name], consent to receive massage therapy and have provided accurate information regarding my health to the best of my knowledge.
Signed: ______________________ Date: [Date]
Full Name: [Name]
Address: [Address]
Phone: [Phone Number]
Email: [Email]
[Referring Practitioner’s Name, if applicable]
[Date]
Have you had any surgeries or major illnesses? Please detail:
[Details]
Do you have any allergies that the massage therapist should be aware of? Please specify:
[Details]
Please explain the primary reason for seeking massage therapy:
[Details]
Please indicate areas where you feel tension or discomfort:
[Details]
Do you have any preferences regarding the type of massage? (e.g., Gentle, Firm)
[Details]
I, [Client’s Full Name], acknowledge and consent to a massage session and confirm my information is correct.
Signature: __________________________ Date: [Date]
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