Antenatal/Postnatal Client Massage Form

The information collected in this form will be used only for the purpose of designing an appropriate massage therapy program for you and will not be disclosed to any third party without your consent.

We reserve the right to request a doctor’s clearance before allowing you to receive massage therapy services.

Please complete the form as thoroughly as possible.

Name *
Date of Birth *
Date of Birth
Address *
Pregnant Clients
My due date is
My due date is
Tick any which apply to you or have in the past
Postnatal Clients
Tick to show you agree with the following terms and conditions
Massage Therapy Acknowledgement