Appointment

At Naseem Sports Therapist, you will receive expert care from highly trained and certified therapists who specialize in advanced sports therapy techniques. Our team is dedicated to providing personalized treatments to help you recover, enhance mobility, and achieve optimal physical well-being.

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Effective communication between the client and therapist is crucial. Clients should communicate their preferences, concerns, and any medical conditions to ensure a safe and enjoyable experience.

Email

info@naseemsportstherapist.co.uk

Phone

+447856964492

CLIENT DETAILS

Pre Appointment Form

Title

DOB:

SURNAME:

GENDER:

FORENAME:

CONTACT NUMBER:

EMAIL:

NAME:

CONTACT NUMBER:

RELATIONSHIP TO YOU:

CONTRAINDICATIONS CHECKLIST

Please reas the following carefully and circle where applicable to inform your Sport Massage Therapist if you currently have, or have had in the past 6 months, any of the following symptoms/conditions:

Musculoskeletal Issues:

Circulatory Issues:

Neurological Issues:

Skin Issues:

Respiratory 'sues:

Immune Issues:

Digestive Issues:

Miscellaneous Issues:

Have you given permission by your GP/ consultant to carry out the treatment? YES/ NO •

Yes No

-->Letter required when treating clients with GP referral contraindications

Have you needed to visit your GP in the last 6 months: YES/ NO

Yes No

DETAILS:

-->I fully understand that thorough and honest responses to these questions are essential for my safety. I hereby confirm that the information stated above is accurate to the of my ability and I undertake to inform my therapist of any changes. I further understand that prior to any treatment a physical assessment needs to be carried out. The procedure has been fully explained to me and I am happy to proceed.

Therapist Name:

Signed

Date

Client Name

Signed

Signed Date

I have read and agree to the Cancellation Policy

Date / Time

First Name

Last Name

Appointment

Book Appointment

Get Expert Health Consultation

Email

Phone

CLIENT DETAILS

Pre Appointment Form

CONTRAINDICATIONS CHECKLIST

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