Massage Intake – Relax with Masiziba

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Massage Intake

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Massage Intake

MASSAGE INTAKE FORM

Client Information

Health Information

Are you taking any medications?
YESNO

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

Are you pregnant?
YESNO

Are you currently under medical supervision or other medical interventions?
YESNO

Areas of broken skin? (e.g., rash, wounds)
YESNO

History of joint replacement surgery?
YESNO

I consent to the massage treatment and confirm the information provided is accurate.

Disclaimer: Thank you for your interest in being a client of Relax with Masiziba. Information collected about new clients is confidential and will be treated accordingly.

Book your rejuvenating experience today to unwind and restore your well-being.

We Are Available:

Mon-Sat: 08.00 am to 5.00 pm

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Contact Details

Phone Number

+44 774 671 5598

Email Address

Info@relaxwithmasiziba.com

Office Location

15 hospital road, Omagh, UK BT790AN

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