Holistic Hideaway - Massage in New Forest

Tel: 07793 532911

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    • Pre-treatment Assessment Form

Pre-Treatment Consultation Form

Please complete this form before your first treatment. Please contact me if you have any questions about filling it in.

Name(Required)
Your preferred phone number
Alternative phone number (optional)
Gender(Required)

Please list any relevant medical history and all medication you are currently taking. Give details of any conditions stating the area affected. If you are not sure whether something is relevant please include it or contact me to discuss.
Have you had a massage before with any other therapist, including spa treatments?
Are you currently being treated by another health professional? Eg. Chiropractor, Osteopath etc.
General health
Do you suffer from any of the following conditions
Please give details of any allergies
Let me know where you feel your pain or issue is. What caused your problem?

 

Your data will be treated confidentially and only used in connection with your treatment. Please see our privacy policy for more information.

Telephone: 07793 532911
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Located at:
30a High Street
Lyndhurst SO43 7BG

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