Charlie Fisher Massage Therapy - Detail & Consent Form

Please complete the form below before your appointment and note that all fields marked with ‘*‘ are mandatory.

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Title:
Name
Please provide your GP surgery name, location and name of your GP if you know it.
What work do you do?
Please let me know your approximate height and weight.
Please provide any key health or injury-related information.
Please provide details of any medication(s) you are currently taking.
Briefly describe your issue and/or pain plus the area(s) you would like treatment to be focused on. If your appointment is purely for general well-being and maintenance, please state so.
BENEFITS & RISKS
BENEFITS:
Massage therapy is known to reduce muscle soreness (including post exercise), enhance well being, promote blood flow, aid healing and reduce muscle tension.

RISKS, THOUGH LOW MAY INCLUDE:
- Feeling sore over the following days (especially if new to massage)
- Aggravation of existing injuries and/or health conditions
- Highlighting of new injuries
- Bruising
Contraindications & Cautions
Please check any or all that apply now or as of recent or check 'none applicable'.
Provide details of who you would like me to contact in the event of an emergency.
Cancellation & Withdrawal From Treatment
Consent