Consultation Form | Nature Radiance Comp

NAME

Address

Email

Phone

Are you taking any medication?

Yes

No

Any allergies?

Yes

No

If yes, please list

Are you pregnant?

Yes

No

Have you had professional massage before?

Yes

No

Disclaimer

I declare the information on this form to be correct; i am physically capable of having treatments and i have completed this form to the best of my knowledge. I will inform my therapist of any health or medical changes.

Signature

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Treatment Consultation Form

Nature Radiance Company