Client Info

More Massage. Less Admin.

✅ Please complete the form, even if you have no health issues.

✅ Just answer what applies and skip the rest.

✅ Your info helps us prepare & maximise your table time.

✅ If we don’t get the form beforehand, we’ll do it in person.

🔒 All information is kept strictly confidential. Please see our Privacy Policy.

Please enable JavaScript in your browser to complete this form.

Where did you hear about us? *

Facebook
Instagram
Normal Web Search
Family or Friend
SPARC
BARK
SNUPIT

Name & Surname *

Email *

Phone *

If you are taking any medications, please list them below.

If you are sensitive to oils, or have allergies or skin issues, please tell us about them.

If you are pregnant, or post-partum, how many months?

If you are currently undergoing medical treatment under a doctor's care, briefly tell us the reason for it.

Any broken skin (rashes, open wounds)?

Any joint replacements/sprains/fractures?

Any chronic pain/tension/limited mobility?

IF THE ANSWER IS "YES", PLEASE CHECK THE BOX. IF THE ANSWER IS "NO", SIMPLY SKIP AHEAD.

Back/neck problems?

Bleeding disorders? Blood Clots?

Areas of swelling?

Bruise easily?

Bursitis?

Cancer?

Contagious condition?

Decreased sensation?

Diabetes?

Fibromyalgia?

Headaches?

Heart Condition?

Hypertension?

Kidney Disease?

Multiple Sclerosis?

Neurological condition?

chronic Acknowledgement TMJ

Neuropathy?

Osteoarthritis?

Osteoporosis?

Phlebitis?

Sciatica?

Seizures?

Stroke?

Tendinitis?

TMJ Disorder?

Varicose veins?

Vertigo/Dizziness?

DVT Disorder?

If you have other conditions or injuries that may affect how we massage you, please tell us here.

Purpose of today’s session (relaxation, pain relief, etc.)?

Areas to focus on if anything?

Areas to avoid if anything?

Light, medium or firm pressure?

Acknowledgement & Consent *

I accept the Terms & Conditions of Jordan Lloyd-Sim Sports Massage Therapy.

1. I have disclosed all relevant medical conditions, injuries, or concerns to my therapist and will report any changes in my health for new sessions. 2. I understand sports massage is not a substitute for medical diagnosis, treatment, or care by a licensed provider. 3. I accept full responsibility for seeking medical advice if my condition requires attention beyond massage therapy. 4. I acknowledge the minor risk of redness, stiffness, bruising, or tenderness following treatment. 5. I agree to indemnify and hold harmless Jordan Lloyd-Sim Sports Massage Therapy from any claims, damages, or liabilities arising from my participation, except in cases of gross negligence or misconduct. 6. I declare the information I’ve provided is accurate and complete, and I consent to treatment by Jordan Lloyd-Sim Sports Massage Therapy.

Please Leave A Review After Your Massage

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Pregnant Client Info

For Pregnant Clients Only

✅ Please complete and submit the form before your appointment.

✅ If we don’t get the form beforehand, we’ll do it in person.

🔒 All information is kept strictly confidential. Please see our Privacy Policy.

Please enable JavaScript in your browser to complete this form.

Where did you hear about us? *

Facebook
Instagram
Normal Web Search
Family or Friend
SPARC
BARK
SNUPIT

Name & Surname *

Email *

Phone *

How many weeks? *

Pregnancy Status *

How has your pregnancy been so far: smooth/some discomfort/complications? Has your doctor or midwife mentioned anything we should be aware of? Please specify.

We use baby‑safe, hypoallergenic, unscented oils. Any allergies or sensitivities we should know about? *

General Health *

Headaches
High or low blood pressure
Shortness of breath
Leg swelling
Tingling or numbness
Old injuries
None of the above
All of the above
Other

Pregnancy Symptoms *

Nausea
Dizziness
Swelling
Back pain
Pelvic pain
Leg cramps
None of the above
All of the above
Other

Discomfort Cue *

Verbal
Hand Signal
Both

List any other conditions or injuries that may affect your massage.

Purpose of today’s session (relaxation, pain relief, etc.)?

Areas to focus on if anything?

Areas to avoid if anything?

Light, medium or firm pressure?

Email Light, hypoallergenic,

Acknowledgement & Consent *

I accept the Terms & Conditions of Jordan Lloyd-Sim Sports Massage Therapy.

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Gift Vouchers

Searching for the perfect gift?

Get a massage gift voucher you can send instantly by email, print to hand-deliver, or share via message — making it quick and easy to give a thoughtful present. Plus, vouchers are activated within 48 hours, so your recipient can start booking their personalized massage right away.

Client Info

More Massage. Less Admin.

Please Leave A Review After Your Massage

Pregnant Client Info

For Pregnant Clients Only

Gift Vouchers

Contact

Address

* Elevators to Level 2 are opposite Clicks in the Courtyard

Phone

Email

Hours