Please enter your full name:
*
First Name
Last Name
Please enter your DOB
*
What is your occupation?
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How did you find out about Project Body?
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Are you right-handed, left-handed, or ambidextrous?
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Have you received any kind of Massage / Manual Therapy before? *
Yes
No
Please tick if you are wearing:
Do you have any restrictions in movement during everyday tasks? Please describe:
Do you sit for long hours at a workstation, computer, or driving? Please describe:
Please tick if you have any difficulties lying: *
Do you perform any repetitive movement in your work, sports, or hobby? Please describe:
Do you experience stress in your work, family, or other aspects of your life? Please describe:
If yes, please tick how you think it has affected your health:
Please indicate how much H2O you drink per day (not including herbal teas, coffee, juices, etc.):
*
Is there a particular area of the body where you are experiencing tension, stiffness, limited range of movement, or other discomfort? Please describe:
Please describe any recent and/or past injuries/operations/conditions:
If you have any scars (old, new, surgical, non-surgical, visible, invisible, including small ones like keyhole scars or mole removal scars), please list them below alongside the cause and date, if you remember.
Are you currently taking any medications? If yes, please list (including dose and frequency):
Please tick if any of the following relate to you: *
Please provide any other information you think is relevant for your treatment session.
Please share any specific treatment goals below:
By ticking below you agree to the following: I have completed this form to the best of my ability and knowledge and agree to keep the practitioner updated to any changes in my medical profile.
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