Fill in your Pre-assessment online here

Client Pre-assessment

Name*

Date of Birth*

Address and Postcode*

Email*

Mobile Number*

Emergency contact/ NOK details*

How did you find out about Retune?

Do you have any allergies to creams, washing powders, or sports tape?*

Do you have any injuries, wounds, broken skin or eczema?*

Do you consent to a hands-on assessment?*

Attach Files

Attachments (0)

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All information is kept confidentially and securely.

Fill in your Medical Preassessment online here (PARQ)

Physical Activity Readiness Questionnaire (PARQ)

Name

Email*

Age*

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*

Do you feel pain in your chest when you do physical activity?*

In the past month, have you had chest pain when you were not doing physical activity?*

Do you lose balance because of dizziness or do you ever lose consciousness?*

Are you pregnant or have you given birth in the last 6 months?*

I have answered these questions to the best of my knowledge and will inform you if anything changes before every session. *

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This is a standard set of screening questions you can expect to be asked when starting to train in a

Your responses will be kept confidential.

Retune Massage and Fitness

Penrhyn Cl, Eastleigh SO50 4QF, UK

07866388939

Back Pain Screening Question

Not all conditions will respond to massage. This questionnaire will help flag up any issues that should be addressed by other medical professionals.

Name

Email*

Have you lost or gained weight in the last 3 months?*

Have you any loss of bladder control, sexual function, or leg power?*

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Retune Massage and Fitness

Penrhyn Cl, Eastleigh SO50 4QF, UK

If you have sudden onset, loss of function in your lower limbs with numbness or pain please seek medical advice immediately. Any information you write here is kept confidential. .07866388939

Downloads

Forms and information available for Download. If you prefer to complete a copy of the client pre-assessment form this is available here. You do not need to submit both a scanned copy and electronic copy.

(The download is more in depth).

If you are having any lower back pain, please read the document 'Lower Back Pain Medical Advice' from the 'Downloads' section..

Retune Massage Client form (pdf)

Download

Lower back pain medical advice (pdf)

Download

Returning clients - Do I need to complete the form again?

Only if your medical or personal details have changed.

Back to booking page Email a scanned copy of the downloaded Form

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