Mobile Massage Treatment Form Mobile Treatments Mobile Treatment - Information Required: First Name * Last Name * Email * Phone Mobile treatment address: * Postcode * No. of treatments on the day: * Length of treatment: (please select) 30 minutes60 minutes90 minutes120 minutes A minimum of 12 square meters uncluttered floor space for the treatment: * Yes No No. of flights of stairs to get to the treatment space: Desired treatment date: Will you be providing your own linen for the massage couch or would you like me to provide it? (Linen required - 1 x hand towel, 1 x bath sheet, 1 x cover sheet) * Yes No Parking information: * Parking available on drive Free street parking Meter Paid parking - please provide hourly rate I understand that the massage therapist will consider information about my physical condition, medical history, lifestyle, stress levels, medications and any areas of physical pain that could affect my massage therapy outcome. I also understand that all information provided will be used purely to help structure the treatment session to achieve my health and wellness goals. I declare that the information that I have given is correct and wish to proceed with treatments. I agree to disclose any medical condition, to determine my overall health and wellness goals Terms and Conditions: We want you to know how our service works and why and how we handle your data. Please state that you have read and agreed to these terms and conditions. reCAPTCHA I have Read and Agree to the Terms and Conditions * Yes Submit
