The Massage Form Template UK is provided in multiple formats, including PDF, Word, and Google Docs, featuring both editable and printable versions for your convenience.
Massage Form Template UK Editable – PrintableSample
Massage Therapy Consent Form Template UK 1. Client Information 2. Emergency Contact Information 3. Medical History 4. Treatment Information 5. Acknowledgment of Risks 6. Consent to Treatment 7. Payment Information 8. Cancellation Policy 9. Client Signature and Agreement 10. Declaration and Signatures
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WORD
Examples
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
Date of Appointment: [Date]
Time of Appointment: [Time]
Location: [Location]
Please describe any medical conditions, allergies, or previous injuries: [Health History Details].
Preferred Type of Massage: [Swedish, Deep Tissue, etc.]
Areas of Focus: [e.g., back, neck, shoulders]
Any areas to avoid: [Specify Areas].
The therapist will perform a brief consultation prior to the session to discuss any concerns and preferences.
I, [Name of the Client], agree to receive massage therapy and understand the nature of the treatment. I acknowledge that I have provided accurate information to the best of my knowledge.
__________________________
[Signature of the Client]
Date: [Date]
[Full Name]
[Client ID Number]
[Home Address]
[Contact Phone Number]
[Email Address]
Session Date: [Date]
Session Time: [Time]
Therapist’s Name: [Therapist Name]
List any existing medical conditions or injuries: [Details].
Are you currently taking any medications? [Yes/No]. If yes, please specify: [Medications].
What type of massage are you looking for? [Type, e.g., Relaxation, Sports].
Preferred pressure level: [Light, Medium, Strong].
A consultation will occur before the session to address contraindications and customize your treatment.
I, [Full Name], consent to receive massage therapy services. I confirm that I have provided accurate health information, and I understand the potential risks and benefits.
__________________________
[Client’s Signature]
Date: [Date]
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