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    Thank you for taking the time to fill out this health questionnaire. Please complete and return the form to me at least 48 hours before your appointment to allow me sufficient time to prepare for your visit.

    All information is strictly confidential and will never be shared or disclosed with third parties. Information will not be shared with referral to another medical professional without your prior written consent.

    All history is totally relevant to how your body responds to everyday activities and injuries so please try to fill in as much information as possible. Often incidents which you feel are nothing could in fact be everything - a drunken fall as a teenager, a small scar, a slight ankle sprain.

     You may choose to skip answering any question you feel impinges on personal information you do not wish to disclose. 

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    About your session

    Your session may contain elements of movement as well as massage and release work. With this in mind, please make sure you are wearing clothes that you can move in. 

  • PRESENTING COMPLAINT

  • GENERAL MEDICAL HISTORY

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  • PREGNANCY AND POST NATAL HEALTH


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