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Tranquility Salon & Rose Petals Beauty Consultation Form

7 Village Mews

Little Common

TN39 4RZ

www.tranquilitysaloneastsussex.com

tranquilitysaloneastsussex@gmail.com

07942863802

Date of Birth
Day
Month
Year
Date and Time of Appointment
Day
Month
Year
Time
HoursMinutes
Are you taking any medications?
Yes, If Yes, Please list below
No
Any Allergies? (oils, lotions, nuts, fruits, skin etc..)
Yes, If Yes, Please list below
No
Are you pregnant?
Yes, If Yes, Please list how many months
No
Are you currently under medical supervision or receiving other medical interventions?
Yes, If Yes, Please describe below
No
Please select any conditions that apply to you.

Massage Information

Have you had proffesional massage before?
Yes, If Yes, How Recently?
No
Reason for seeking massage:
Relaxation
Specific Problem
How much pressure do you prefer:

By signing below, i acknowledge that I am aware of the benefits and risks of massage therapy and i have completed this form to the best of my knowledge. i also agree to inform my massage therapist of any health or medical changes.

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