New Client Intake Form for Bodyworks

Thank you for booking with Bodyworks Massage Therapy.

As a new client it’s important that we learn a little more about you and how we can help, so we’d appreciate if you could fill out our Client Intake Form below before your appointment. Once you complete the form, there’s no need to arrive early.

Your first session will begin with some assessment. (Unless you’re wanting a full relaxation session, in which case it’ll just be a quick chat.) This will allow us to figure out where to start treatment - because what hurts isn't always where the problem is. We can then agree on a treatment plan and go from there.

If you've never had a massage before, just so you know, you'll always be covered up on the massage table, and your therapist will leave the room to let you get undressed (leaving underwear on) and dressed again after. The only area exposed is where we’re working - and that will never involve "private" areas. And don't worry about hairy legs or backs, fat bits, skinny bits or anything else you'd rather not let anyone see - trust us - we've seen it all and you're not judged by it! We do ask if you're planning to see us immediately after exercise, that you shower first. We have a range of music available to play during your session, but you're also welcome to bring your own iPod/phone/MP3 player and play your own music.

For your convenience, you can pay by EFTPOS, or good old cash. If you have a gift voucher, there's no need to bring it if you entered the number online when you booked.

Contact details

Firstname:
Surname:
Address:
Suburb:
Town/City:
Email:
Mobile Ph:
Home Ph:
Work Ph:
Date of Birth (dd/mm/yy):
Occupation/Main work:
How did you hear about us? If someone referred you, who was it?
What sport/exercise do you do and how often?:

If you are wanting pure relaxation massage from us, then you can skip the next section and go to the bottom of the page, however you might like to complete the next section so we know where to focus.

Present Problem/Condition

What is your current main problem or condition and where?
Is it getting progressively worse?	Yes No Comes & goes
Rate your current pain/discomfort level. 0 = no pain, 10 = worst pain you can imagine
What aggravates your condition?
What have you done to get any relief?
Has it been medically diagnosed? Is yes, by whom and what was the diagnosis?
Have you had any surgery? List as many as you can remember with the approx. year
Have you had any accidents or injuries? List as many as you can remember with the approx. year

We'd like to be able to contact you occasionally with information regarding massage therapy and general healthcare, as well as special promotions related to our business. Please tick if you ONLY IF YOU DON'T WANT to receive this information. Your information will not be shared with any other company and you can update it at any time by contacting us at rachel@bodyworksmassage.co.nz . We respect your privacy under the Privacy Act 1993 and we promise we will not be spamming you!

And if anything crops up and you're not able to make your appointment, we'd appreciate if you could let us know 24 hours in advance - that will give us a chance to perhaps get another booking in your place. If you don’t give 24 hours’ notice, you may be charged a cancellation fee or forfeit your gift voucher.