Massage Registration Form

This form is mandatory for all new massage clients. The information is required to ensure you receive a safe massage that is tailored to your needs. The information provided is for our personal use only and will be stored in a safe manner consistent with GDPR requirements. See our Private Policy here.

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Personal Details

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Your email address is used primarily to contact you about your appointment(s). We may also send you occasional updates or special offers regarding our massage services. You can unsubscribe from these updates at any time. If you do not wish to receive these updates, please tick below.

Health Assessment

Age group (required)

Massage treatments cannot be given to clients suffering from any of the following:

  • Covid 19
  • Flu
  • High fever
  • Any other contagious or infectious disease
  • Severe allergies (especially to seed or nut oils, essential oils, fragrances or creams)
  • Severe skin diseases/conditions (including dermatitis, psoriasis and eczema)
  • Severe asthma
  • Undiagnosed lumps and bumps
  • Severe bruising
  • Severe sunburn
  • Severe swelling or inflammation
  • Hernia
  • While under the influence of drugs or alcohol
Do you suffer from any of the following (tick all that apply)

Please note that the conditions listed above are contra-indications for massage and require medical permission before treatment. Where medical permission cannot be obtained, clients must give their informed consent prior to treatment.

Do you have any nut allergies? (required)

So that we can tailor your massage to your needs, please tick any items below that apply to you:

Declaration and Signature

For personal safety reasons, your name, phone number, eircode and the date and time of your appointment is shared with a third party in advance of each appointment. These details are stored in line with GDPR regulations and are deleted by the third party immediately after the treatment.

To ensure a safe and beneficial treatment, it is essential that you have answered all questions above fully & honestly and that you are aware that certain conditions restrict the ability to receive a massage treatment.