forms | Raava Holistic

Raava Holistic Therapies Consultation Form

Personal Information

First name

Last name

Address

Phone

Birthday

Day

Month

Year

Health Information

Do you have any existing health conditions?

Are you currently pregnant?

Are you currently breast feeding?

Are you taking any medication?

Do you have any allergies (e.g., nuts, oils, lotions, herbs)?

What is your primary reason for booking this session?

Please provide a brief description of what you’re hoping to achieve from this treatment (e.g., relaxation, pain relief, stress reduction, etc.

Do you have any areas of tension or discomfort?

Please specify any areas of your body that you feel need particular attention during the session.

Do you have any previous injuries or surgeries we should know about?

Do you have any preferences for the type of treatment or pressure during your session?

Is there anything else we should know to make your treatment more effective or comfortable?

Please provide any additional information you feel is important for us to know before your appointment.

Signature and Consent

By submitting this form, I consent to receiving bodywork services and confirm that the information provided is accurate to the best of my knowledge. I understand that it is my responsibility to inform my therapist of any changes to my health status before the session.

Signature

Signature field is empty.