MASSAGE

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MASSAGE

CONSULTATION CARD

Name of client……………………………………………………………………………………...
Sex………………………………………………. Age ……………………………………………
Date…………………………………………………………………………………………………
Address…………………………………………………………………………………………….
Cell no……………………………………………………………………………………………...
Email……………………………………………………………………………………………….
Next of Kin…………………………………………………………………………………………
Address……………………………………………………………………………………………
Doctor’s Name……………………………………………………………………………………..
Address…………………………………………………………………………………………….

MEDICAL HISTORY
Diabetic Allergic Cancer Asthma

CONTRAINDICATIONS
Cuts Wounds Bruises Rush

SKIN TYPE
Dry Oily Normal Sensitive

Home care
advice……………………………………………………………………………………………
Name of therapist………………………………………………………………………………….
Client Signature…………………………………………………………………………………...
Date of next visit…………………………………………………………………………………
Therapist Signature……………………………………………………………………………….

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