Book Massage - ALYSSA DRAKE

Let's Get Started

By Completing this online consultation form, our time together will be maximised for your overall massage experience.

Please take your time with this form, ensuring it is filled out to the best of your knowledge.

On completion of your form, an email will be sent with confirmation - If you are requesting a time outside of what is currently available in my booking system I will endeavour to respond to your request within 24-48 hours

Looking forward to our session together. Lissy

30 MINUTES - $60

45 MINUTE MASSAGE - $90

1 HOUR - $120

Full Name (include middle names) *

Name Known As

DATE OF BIRTH (18+) *

Email address *

PHYSICAL ADDRESS *

MOBILE NUMBER *

CURRENT OCCUPATION *

MASSAGE SESSION *

What is your main reason(s) for booking this session? *

MEDICAL history/ CONDITIONS *

**Please also let me know if you have any known family medical history of importance

CURRENT MEDICATION/DRUGS/SUPPLEMENTS (AND WHAT IS IT PRESCRIBED/USED FOR?) *

LIST past/present PHYSICAL INJURIES/SURGERIES *

CURRENT AREA(S) OF TENSION/PAIN *

RATE YOUR CURRENT LEVEL OF DAILY PAIN FROM 1-10 (1 BEING NONE, 10 BEING WORST PAIN IMAGINABLE) *

MORE INFO

HOW WOULD YOU RATE YOUR LEVEL OF SLEEP *

SLEEP

WHAT IS YOUR NORMAL SLEEP CYCLE?

DO YOU WAKE IN THE MORNING feeling... *

WATER INTAKE *

CIGARETTES/VAPE? *

ALCOHOL CONSUMPTION *

EXERCISE *

GENERAL MESSAGE

BOOKING FORM

Let's Get Started