Pre-visit consultation

Before your massage.

A quick health screening so your therapist can treat you safely. A few minutes now means less form-filling when you arrive.

Step 1 of 4

Your details.

First name *

Last name optional

Email *

Phone *

Date of birth optional

Postcode optional

Occupation optional

Because massage is hands-on, we ask for an emergency contact.

Emergency contact name *

Emergency contact phone *

Relationship to client optional

Your preferences.

What's bringing you in for a massage? *

Have you had a professional massage before? optional

YesNo

Relaxation or a specific problem? *

RelaxationSpecific problem

Preferred pressure *

LightMediumFirm

Areas of discomfort optional

Health screening.

Yes/no is enough unless we ask for detail — this stays confidential and is only seen by the studio.

Taking any medications? YesNo

Any allergies (oils, lotions, nuts, fruits, skin products etc.)? YesNo

Currently under medical supervision / receiving medical interventions? YesNo

Recent injuries or medical procedures in the past 2 years? YesNo

Currently pregnant? YesNo

Areas of broken skin (rash, wounds etc.)? YesNo

History of joint replacement surgery? YesNo

None of the following apply to me

Please tick any that apply

Areas of swelling Autoimmune disorder Back / neck problems Bleeding disorders Blood clots Bruise easily Bursitis Cancer Contagious condition Decreased sensation Diabetes Fibromyalgia Headaches Heart condition Hypertension Kidney disease Multiple sclerosis Neurological condition Neuropathy Osteoarthritis

Anything else we should know? optional

Consent & signature.

I acknowledge that I am aware of the benefits and risks of massage therapy and that I have completed this form accurately and to the best of my knowledge. I agree to inform my Hair Aesthetics Club therapist of any health, medical or medication changes that may affect treatment.

I have read and agree to the above *

Type your full name as your signature *

Thank you.

Your consultation form has been received. We'll review it before your appointment — see you soon.