Consultation - Massage Service

Your names

Your email

Mobile Number/Whatsapp

DOB

Wedding Anniversary

Referral (optional)
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Do you have any allergies?
If yes, please specify on the field above.

Are you currently taking any medications?
If yes, please specify on the field above.

Are you pregnant or nursing? (Female only)
If yes, please specify on the field above.

Have you been recently hospitalized?
If yes, please specify on the field above.

Do you have any current injuries?

If yes, please specify on the field above.

Current medical conditions like Asthma, Diabetes, Heart problems, Kidney problems, epilepsy, scoliosis, communicable disease, Blood pressure etc.?
If yes, please specify on the field above.

Location of painful areas

I, undersigned, agree with the following statements:

Professional Boundaries:
Massage therapy is strictly professional. Any form of sexual misconduct, harassment, or inappropriate behavior is strictly prohibited.

- I will respect the therapist’s boundaries and professionalism at all times.
- The therapist has the right to terminate the session immediately if inappropriate behavior occurs.

Draping policy:
I understand that appropriate draping will be used at all times to ensure my comfort and privacy.
Only the areas being treated will be exposed, and sensitive areas such as genitals and breasts (for women) will always remain covered and untouched.

Therapist Conduct:
I understand that the therapist is trained to maintain professional and ethical behavior throughout the session.
The therapist will never make inappropriate comments, advances, or gestures toward me as the client.

Date Signed