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Massage Health Form

Please complete the form to the best of your knowledge and be assured that it will be treated in the strictest confidence. The questionnaire is designed to make sure that you can practice safely. If there is anything you are unsure about or would like to chat through, please get in touch.

Before you fill out this questionnaire and send the form back to Nurtured Soul, we advise you read the privacy policy so you understand and accept what happens to your data. By you forwarding the questionnaire on to us, we will assume you accept the privacy policies stated

Birthday
Day
Month
Year
Are you taking any medications?
Yes
No
Any allergies? (oils, lotions, nuts, fruits, skin, etc.)
Yes
No
Are you pregnant?
Yes
No
Are you you currently under medical supervision or receiving other medical interventions?
Yes
No
Please tick all that apply
Recent injuries or medical procedures in the past 2 years?
Yes
No
Have you had professional massage before?
Yes
No
Reason for massage?
Relaxation
Stress release
Specific issue
How much pressure do you prefer?
Firm
Light
Medium
When would you prefer your appointment?
Declaration
Please tick if you agree with this statement
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