MASSAGE
MASSAGE
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……………………………………………………………………………….