07-3483-0421
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New Massage Client Form

YOUR DETAILS

For example 1st January 1980 should be input as 01/01/1980
Please include the area code for home and work phone numbers.

What type of therapy (or therapies) would you prefer?

What level of care would you prefer?

Would you like a reminder the day before an appointment?

Cancellation Policy:
Our policy is that any missed appointments, or appointments cancelled with less than 24 hrs notice, must be paid for. (Please note that not receiving a SMS or an email reminder will not be accepted as a reason for missing an appointment.)

MASSAGE INFORMATION

(0 being no pain - 10 being extreme pain)

Please mark if you have had any of the following symptoms/ conditions (past or present)

Free service - Would you like an SMS once or twice a week advising what massage times are available?
Sending