Consultation form - Natural Touch Massage

Your first name *

Reference (from your booking confirmation) *

Have you experienced any cold or flu-like symptoms in the last 10 days (including fever, cough, sore throat, respiratory illness, difficulty breathing)? *

Yes
No

If yes, please give details

Please tell us about any health conditions or allergies you have or if you are pregnant

Name of an emergency contact

Emergency contact number

Please complete two days before your massage