Before your massage with me, I require you to COMPLETE and SUBMIT this consultation form. All information will remain strictly confidential. If you want to fill in a consultation form for a pregnancy massage or for the baby massage course please follow the links below.
Massage Consultation Form
Are you pregnant?
CHANGES IN MENSTRUAL CYCLE
CHANGES IN FREQUENCY OF URINATION
BURNING SENSATION ON URINATION
PROBLEMS PASSING WATER (URINATION)
Shortness of breath
Do you suffer from any of the following?
Are You Pregnant?
Changes In Menstrual Cycle
Changes In Frequency Of Urination
Burning Sensation On Urination
Problems passing water (urination)
Shortness Of Breath
Do you suffer from any of the following? Please answer Yes or No to each of the following