Full Name
Age
Nationality
Occupation
Address
Do you have any injuries or special conditions?
Are you taking any medications or supplements?
What areas would you like to focus on today?
Are there any pre-existing issues that the therapist needs to be aware of?
*Therapy during pregnancy is not advised.
*You should wait at least 45 minutes after eating before treatment.
*Please advise what pressure you would like during the treatment or if you feel any pain.
*Do not consume drugs or alcohol before treatment.
THANK YOU FOR SUBMITTING!