4 week baby massage course
massage consultation form
Before your massage with me, I require you to COMPLETE and SUBMIT this consultation form. All information will remain strictly confidential.
If you would like a deep tissue, manual lymphatic drainage or swedish massage with me then please follow the link below.
If you are interested in the 4 week baby massage course please follow the link below.
Pregnancy Consultation Form
Please answer Yes OR No to indicate a current or past problem
Abdominal Cramping
Chronic Hypertension
Blood Clot Or Phlebitis
Uterine Bleeding
Bladder Infection
Leaking amniotic fluid or vaginal bleeding
Anaemia
Please answer Yes/No to indicate a current or past problem
Current Problem
Past Problem
Abdominal Cramping
Chronic hypertension
Blood clot or phlebitis
Uterine bleeding
Bladder infection
Leaking amniotic fluid or vaginal bleeding
Anaemia
Stress levels 1-10 (10 highest)
