Consultation Form

You can use this form to submit your details, whether you are coming to your free taster, first appointment or to update your details.

This is for GDPR compliance. Please choose all the ways you would like to be contacted
The type of work you do can indicate how pain develops (ie office work, lots of driving, manual work etc)
Select all that apply. If you have a medical condition that isn't listed, you can add them in medical history details below
Please give details of an medications you are taking. Is there anything about your health and wellbeing you would like to tell us.
Pregnancy can be a contrindication for massage if you are up to 14 weeks.
Please let us know of any areas of pain. List them in the order of your priority. Say how they are affecting your daily life
Are there any activities or movements that you are avoiding?
Is there anything that improves your current problems.
Selected Value: 0
Rate your mood (0=poor, 10=excellent)
Selected Value: 0
Rate your stress levels (0 =poor, 10=no stress)
Selected Value: 0
Rate the quality of your sleep (0=poor, 10=no sleep problems)
What are your reasons for seeking treatment ?