body-vacation

Pre-treatment Assessment

For new clients, a per-consultation may be performed to ensure suitability for massage, to gather relevant medical history to understand the issues experienced and to explain what you can expect from the massage.

Please complete the form below and return it to massage@bodyvacation.co.uk at least 24 hours before your scheduled massage.

Note: All information provided will be treated in the strictest confidence and will not be shared.


1. First Name: (required)

2. Surname: (required)

3. Your Email: (required)

4. Contact Number: (required)

5. Occupation:

6. Frequency of exercise per week: Never1-3 times a week3-4 times a weekmore than 4 times a week


7. What is your general health like?: ExcellentGoodFairPoor


8. Have you had any accidents in the last 5 years?: YesNo

If yes, please state:

9. Have you had any illnesses in the last 5 years?: YesNo

If yes, please state:

10. Have you had any operations in the last 5 years?: YesNo

If yes, please state:

11. Are you on any medication?: YesNo

If yes, please state:

12. Do you have any present health or wellbeing complaints?: YesNo

If yes, please state:

13. Please rate the level of stress, if any, you are under (1=none and 5=high):

At home: 12345

At work: 12345


14. Please tell us about any other possible conditions that may impact on you having a massage :

15. Please insert code:   captcha