top of page

Aglow Massage

Sports, Hot Stone, Manual Lymphatic Drainage, Deep Tissue, Holistic & Natural Lift Face Massage

Home
Book Online
Contact
Gift Card
Massage Consultation
Testimonials
About
Sports Massage
Manual Lymphatic Drainage Massage
Deep Tissue Massage
Hot Stone Massage
Natural Lift Face Massage
Services
Privacy Policy
What is Massage
More

Use tab to navigate through the menu items.

Personal Information

First name

Last name

Email

Phone

Date of birth

Medical Information

Are you taking any medications*

No

Yes

Are you currently pregnant?*

No

Yes

Do you suffer from chronic pain?*

No

Yes

Do you have any orthopedic injuries?*

No

Yes

Please indicate any of the following that apply to you

Cancer

Headaches/Migranes

Arthritis

Diabetes

Joint replacements

High/Low blood pressure

Neuropathy

Fibromyalgia

Stroke

Heart Attack

Kidney dysfunction

Blood clots

Numbness

Sprains or strains

Explain any conditions you have indicated above

Massage Information

Have you had a massage before*

No

Yes

What type of massage are you seeking?

Sports

Hot Stone

Lymphatic Drainage

Deep Tissue

Natural Lift Face

What pressure do you prefer

Light

Medium

Deep

Do You Have any allergies/sensitivities?*

No

Yes

Any areas you do not want massaged (feet, face, abdomen, etc.)*

No

Yes

What are your goals for this treatment session?

I declare that the info I’ve provided is accurate and complete.

I declare I have GP or specialist consent for massage if I have medical conditions.

Initials*

Massage Consultation Form

Please fill in before you attend your appointment

bottom of page