Name*

First Last

Date of Birth*

Email*

Enter Email Confirm Email

Your email will NOT be shared with any third parties.

Phone - Preferred*

How did you find out about our services?

If referred by client could you provide a name please. Thanks.

Are you involved in any sport / leisure / recreation?*

List any other sport / leisure / recreation?

Please include any activities you are involved in that may further our understanding of your needs.

Have you had / or are you currently having any kind of treatment/s? Please list:*

Any current injury and/or condition requiring attention or care:*

What are some goals / outcomes you would like to achieve from your treatment?

CHECK ALL OF THE FOLLOWING CONDITIONS WHICH YOU ARE EXPERIENCING

Further explanation on existing or other conditions:

Do you wear contacts?*

Do you have any infectious conditions: HIV; Hep A, B, C; Other:*

Any recent surgeries?*

Any medication you are currently taking:*

LEGAL INFORMATION: By submitting this form, I agree that I have read and understand the following -*

Agree

I understand that both massage and exercise are not a replacement for medical care and that no medical diagnosis will be made. Because massage and exercise may be contraindicated due to certain medical conditions, I affirm that I have informed the therapist of all known medical conditions and will keep the therapist updated as to any changes in my medical condition going forward. If I experience any pain or discomfort during the session and/or class, I will immediately inform the therapist so that: In a Soft Tissue treatment the pressure and/or manipulation, draping or environment may be adjusted to my level of comfort. OR, In a class or Personal Training session your trainer/class facilitator will make adjustments to allow you to participate at a level appropriate to your ability and current capacity.

EMAIL POLICY*

Yes, I got it.

Your privacy is important to us. We will only use you email for appointments, some promotion, and news about OLOS Health. We will not give your details to anyone. Any news or promotional emails will provide the option to subscribe at the bottom.

IN CASE OF CANCELLATION*

I AGREE

I agree to give 24 hours advance notice of scheduled session, or to assume responsibility for payment of the full fee.

We are moving. From Monday 17 August, sessions are at Clifton Hill. Bookings continue as normal.

Welcome to our online Client History Form

New Client History Form

OUR PROMISE