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    Personal Details
    Emergency Contact:
    Terms & Conditions:

    It's important to discuss with your therapist the specific areas you'd like them to focus on. If you have any issues with your massage therapy, please inform your masseur during your therapy and at the reception immediately after. We will not accept complaints and will not offer refunds thereafter.

    Medical Information
    Are you taking any medications? YesNo
    Are you currently pregnant? YesNo
    Do you suffer from chronic pain? YesNo
    Have you had any orthopedic injuries? YesNo
    Please indicate any of the following that apply to you CancerMigraineArthritisDiabetesJoint ReplacementsHigh or Low Blood PressureNeuropathyFibromyalgiaStrokeHeart AttackKidney DysfunctionBlood ClotsNumbnessSprains or Strains
    Areas of Discomfort Head / face / jawNeck / throatShouldersUpper backMid backLower backChest / ribsAbdomen / stomachPelvis / hips / groinArms / elbows / wrists / fingersButtocksThighs / kneesLower legs / ankles / feet / toesOther
    Massage Information
    Have you had a professional massage before? YesNo
    What type of massage are you seeking? RelaxationTherapeutic/Deep TissueOther
    What pressure do you prefer? LightMediumDeep
    Do you have any allergies / sensitivities? YesNo
    Are there any areas you do not want massaged? (feet, face, abdomen etc.) YesNo
    By signing below, you agree to the following.

    I have completed this form to the best of my ability and knowledge and agree to the Terms & Conditions and Inform my therapist if any of the above information changes at any time.

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    Very professional

    Very professional and as a first massage post Covid19 lockdown it was definitely needed.

    Karan

    Love the place

    I have never been disappointed with a massage here…. I love the place. Thanks so much xx

    Deborah

    Extremely pleased

    First ever Thai full body massage, so little unsure what expect, was well looked after and was extremely pleased with the effect on knots in back. More work needed will definitely return.

    Alec

    Feeling much better

    My back and legs were very tense so she worked hard to relieve all the aches, pains and knots, especially in my right shoulder. A few painful moments, but I felt so much better afterwards.

    Mark
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