MASSAGE

Thank you for booking into a Healthworks Seated Massage. Please read and complete the following questionnaire and sign the form below.
Field is required!
Please answer the following COVID-19 related questions below:

 


Do you have any symptoms such as fever, cough, sore throat, runny nose, shortness of breath or fatigue?
Field is required!
Have you been in contact with anyone who has been unwell with respiratory symptoms, fever or a suspected or confirmed case of COVID-19 in the past 14 days?
Field is required!
Have you travelled domestically or internationally in the last 14 days?
Field is required!
Do you currently reside in, or have you travelled to/spent more than 15 minutes in any of the recognised Australian “hotspot” locations within the last 14 days?
Field is required!
Please answer the following massage related questions below:

 


Is this your first massage?
Field is required!
What is your preferred massage pressure?
Field is required!
Note that the maximum massage chair safe weight limit is 110kg.
PARTICIPATION CONSENT
I hereby give consent for massage therapy. I have provided my medical history. I do not expect the therapist to have foreseen any previous or pre-existing condition that I have not mentioned.

I understand that massage may provide benefits for certain conditions but results are not guaranteed. These benefits may include relief of muscular tension, relaxation, reduction in the symptoms of stress-related conditions and provision of general wellbeing. I also understand that massage therapy may produce side effects such as muscle soreness, mild bruising, increased awareness of areas of pain and light-headedness amongst other possible temporary outcomes.

I am aware that the therapist does not diagnose illnesses, prescribe medications nor physically manipulate the spine or its immediate articulations.

I will tell the therapist about any discomfort I may experience during the massage session and understand that the massage will be adjusted accordingly.
Field is required!
Field is required!