Massage Consent Form

All information will remain strictly confidential.

Client Details

Name: *

Mobile: *

Home Tel:

Email: *

Address:

Post Code:

Date of Birth: *

Health Information

Do any of these health conditions apply to you?

If you have ticked any of the conditions above, or ticked "Other", please give details:

Are you currently taking any medication? *

Please give details:

I will inform the therapist of any changes to my medical status before each and every treatment. *

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Consent

I have agreed to undergo this therapy.
I am fully aware that the services I wish to receive are those of a holistic nature and do not serve as a substitute for professional medical advice, examination, diagnosis or treatment.
I understand that if I have been untruthful with my details or have failed to give enough relevant information the outcome of any treatment could be adversely affected.
I understand the therapist does not claim to cure or to diagnose any medical condition in the same way as a doctor/physician.
I confirm that I have given my personal details for the therapist’s use in connection with the treatment and consent to the storage of these details for at least ten years.
I confirm that you may retain this information so that you can contact me again in the future.
I confirm that I give full consent to receive the massage therapy.

Client Signature: *

Tap or click on the signature above to sign

Covid-19 Guidance

Appointment Guidance

- Please only attend at your appointment time

- Please ensure you are on time - if you are late this may result in your appointment being cancelled

- Please attend your appointment unaccompanied

- Please limit the personal possessions you bring with you

- Hand sanitiser will be provided upon arrival and will be available throughout your appointment

- Please wear a face covering to enter and walk around the salon/clinic

- We encourage contacless/card payments where possible

- If you experience Covid-19 symptoms after your appointment please contact us immediately

Have you, or anyone in your household, had any of the following symptoms in the last 14 days: dry cough, fever, high temperature, shortness of breath, loss of sense of taste or smell, sore throat? *

Please DO NOT attend your appointment. Please contact us to cancel / reschedule.

Have you, or anyone in your household, been in contact with any confirmed COVID-19 positive patients? *

Please DO NOT attend your appointment. Please contact us to cancel / reschedule.

Data Protection and Privacy

We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.