If you are a new client, please take a moment to carefully fill out this form.
If you check yes to any of the following conditions, please explain as clearly as possible.
If you have a specific medical condition, or symptoms of a medical condition, massage may be contraindicated. 
A clearance from your GP to receive massage therapy may be required prior to massage service being provided.

(Please understand that if you decline to give the above permission I will unfortunately be unable to deliver any services to you)
(This is completely voluntary and you are under no obligation to agree. This will not affect how I treat you)