Massage Therapy Form – Kings Canterbury Sports Centre
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Massage Therapy Form

Massage Therapy Consultation Form

Our Massage Therapy Consultation Form is a detailed questionnaire used by our therapists to gather crucial client information to ensure a safe, effective, and personalised massage treatment.

This field is for validation purposes and should be left unchanged.

Client Information

Name(Required)
DD slash MM slash YYYY
Is the client aged under 18? (minimum 16 years)

Appointment Preferences

Preferred Day(s)(Required)
Preferred Time(Required)
Preferred Instructor / Therapist (if any(Required)
Massage Duration(Required)

Please let us know the main reason(s) you are seeking massage therapy (e.g. relaxation, injury recovery, pain relief, stress management, sports performance, mobility, etc).

Medical History & Health Information(Required)
To ensure your safety and provide the most effective treatment, please share any relevant medical history or current conditions. You may include injuries, surgeries, chronic conditions, allergies, pregnancy, medications, or anything else you feel is important.

I confirm that I am the parent/legal guardian of the above-named child and give permission for them to receive massage therapy treatment provided by the therapist at this facility.

Consent & Acknowledgement(Required)
Please print full name
I confirm that I am the parent/legal guardian of the above-named child and give permission for them to receive massage therapy treatment provided by the therapist at this facility. Please print full name
DD slash MM slash YYYY