General Client Details
Are you currently experiencing OR ever been diagnosed with any of the following conditions?
If you selected 'none of the above', please mark N/A in space provided.
Please note pregnancy massage is not currently a service offered at LiveWell. We do offer specialist pregnancy physiotherapy services. If you are booked in for a massage therapy service, it is essential that you contact the clinic to discuss an alternative to a massage appointment if you are currently pregnant.
Massage and Lifestyle Information
In order to optimise your massage experience and tailor it to best suit your needs, it is helpful for your therapist to be aware of your massage preferences as well as general lifestyle information. If you do not wish to answer any questions, please leave blank and your therapist will discuss this form with you prior to massage intervention.
For example: Feet, abdomen, face, head. Please explain so that your therapist can discuss with you prior to massage.
For example: Stress relief, relief of tension, calming. Please outline for your therapist so that they can discuss prior to your massage.
If you have no information to add, mark N/A in the space provided.
Client Informed Consent
Massage therapy involves the application of soft tissue techniques to the body. It is essential that you confirm that you have answered this form to the best of your ability and knowledge. It is your responsibility to inform your therapist if there is any change to your medical information as this may impact your suitability and safety for massage. You must also inform your therapist should you feel unwell at any time during your massage. Clients are advised to hydrate with water following massage and to take sufficient time to get dressed and feel ready to leave their treatment room.
Your comfort is paramount during a massage. The nature of massage is such that you will be required to have body areas exposed. While towels are used to drape and cover body areas to ensure your maximum comfort, It is your responsibility to inform your therapist, at any time, if you should feel uncomfortable or wish to stop the massage. Towels are used to cover body areas at all times. Underwear is always kept on throughout massage appointment. The massage may incorporate lying on your back, tummy or onto each side. It is your responsibility to inform your therapist should you feel uncomfortable in any position or need to change. You also acknowledge that you have disclosed any allergies or skin senstivities in order that the likelihood of any skin/allergic reaction is minimised.
THIS INFORMATION IS PROTECTED BY THE DATA PROTECTION ACT 1984.