Massage Consent Form
Please complete this form to provide relevant information for your massage therapist & consent to treatment.
  • Personal Details

  • Next of Kin Details

    Please provide details of the person you would like us to contact in case of an emergency
  • Medical History

    Please provide relevant medical history
  • Do you have a current or recent history with any of the following conditions?

  • Review & Submit

    I understand cancellations require no less than 24hrs notice by telephoning South Yarra Fitness on 03 9827 0083 or Andrew on 0422 883 520.
    Late cancellations will incur a 50% cancellation fee.

    I have accurately declared all injuries and medical conditions and consent to treatment.