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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

Once you submit your request, we’ll reach out within one business day to confirm the appointment details and ensure the best possible match for your needs.

Trusted by 1000+ patients

Sarah M.

★★★★★

I recently found myself in need of an urgent massage appointment and was exceptionally fortunate to discover Naseem. Her expertise swiftly alleviated my pain — therapeutic and pleasant experience!

1 month ago

James T.

★★★★★

Possibly the best massage I have ever had! My back feels relaxed and much better. The atmosphere was warm and welcoming.

2 months ago

Emily R.

★★★★★

I travel from HX for treatment. My neck and shoulder stiffness has improved significantly. Very professional care.

1 week ago

Daniel K.

★★★★★

I attended for lower back and knee pain. I feel much better than before and always have a positive experience.

1 month ago

Aisha L.

★★★★★

Excellent spa experience. Clean, calm and professional environment. Highly recommend.

3 weeks ago

Michael S.

★★★★★

After just two sessions, my mobility improved greatly. Professional, knowledgeable and caring therapist.

2 months ago