Swedish Massage

Client Forms

GDPR Form

The GDPR (General Data Protection Regulation) Form sets out how Willow Tree Massage will use information collected about you. It also covers my obligations and your rights to these data.

Please download, read and keep the GDPR Form for your future reference.

Download
GDPR Form
(pdf)

You will be asked to confirm and sign you have read this document at your initial consultation.
 

Consultation Form

To save time at your initial consultation, you can complete most of your Consultation Form in advance. We can then concentrate on specific areas straight away.

You can download, print and complete your Consultation Form. And bring it with you to your first appointment.

Download
Consultation Form
(pdf)

Alternatively, you can complete and submit the Online Consultation Form below.

Please note, you will need to complete the online form in one sitting. You cannot save and return to the form.

    Willow Tree Massage Consultation Form (Online)

    (Best viewed in Landscape on a mobile)

    Your Details

    Full Name:

    Email Address:

    Telephone Number:

    Date of Birth:

    Gender:

    Profession:

    Medical Background

    Please state your reason for booking a massage treatment:

    Any medical conditions your therapist needs to be aware of:

    Are you currently taking any prescribed medication:

    Have you ever undergone an operation or plan to have any surgery or medical tests:

    Contraindications

    Do you, or have you, ever suffered from any of the following:

    CellulitisContagious diseasesThrombosis / DVTPhlebitisSevere undiagnosed headachesAneurysmStrokeUndiagnosed illnessGangreneHaemophiliaVaricose veinsInflammatory conditionsArthritisHeadachesMigrainesDiabetesSunburnCancerAnxietyUncontrolled high blood pressureDepression

    Severe numbnessRecent scar tissueHeart conditionHIV/AidsUnstable/replaced jointsHepatitisEpilepsySevere undiagnosed painBone fracturesSprainsNervous system conditionsSevere bruisingAllergiesMuscular spasmsIBSFeverOedemaSkin disorders / Any cutsAsthmaAny injuriesOsteoporosis

    Aches and Pains

    Pain rating on a scale of 1 to 10 (10 being the worst)

    Back

    Neck

    Shoulders

    Knee

    Stiff Joints

    Females

    Are you pregnant:

    YesNo

    If yes, how many months:

    Do you have a contraceptive implant:

    YesNo

    Stress

    How would you rate your stress levels on a scale of 1 – 10 (10 being the worst):

    Sleep

    How many hours sleep do you get on average:

    Do you feel tired during the day:

    YesNo

     
    Please check over you answers.

    When you are ready click on “Send Form” below.

    Thank you.