Client Questionnaire Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Emergency Contact * Known medical conditions * Known allergies * Current medications * Are you Pregnant? * No Yes Have you ever had a massage before? If so, have you had acupressure massage? * Have you eaten within the last 4 hours? * No Yes Do you have a history of fainting, dizziness, or low blood pressure? * Do you have any aches and pains, injuries or stiffness? * Cancellation Policy * I confirm that I have read the cancellation policy. Understanding * I understand that this treatment is not a replacement for any medical treatment prescribed by your GP, but is a form of health maintenance. Responsibility * I take responsibility for alerting my practitioner to any condition which may affect my ability to receive the massage. Covid 19 * Please confirm that you do not have Covid 19 or any cold/cough in the last week. Thank you!
