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Flow Massage Wanaka

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Client Health Information and Consent Form

Please complete the form before your first appointment

Full Name

Email

What is your occupation?

Phone number

Date of Birth * required

What is your address?

Emergency contact

Do you have an allergies or have sensitive skin?

Are there an area/s were you are tender or generally hold tension or discomfort?

Do you have any past/present injuries of relevance?

Any other health issues?

How did you hear about us?

I consent that Flow Massage is not responsible for any physical injuries. Or provide any medical diagnosis or prescribe medical treatment.

Thanks for submitting!

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