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 - I will endeavor to confirm this booking within 24-48 hours with my next available dates/times.

Invoicing for your session will be sent out via email once your booking date/time has been confirmed.

Looking forward to our session together. Lissy

45 MINUTE MASSAGE - $80

Full Name (include middle names) *

Name Known As

DATE OF BIRTH (18+) *

Email address *

PHYSICAL ADDRESS *

MOBILE NUMBER *

CURRENT OCCUPATION *

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

SLEEP

WHAT IS YOUR NORMAL SLEEP CYCLE?

DO YOU WAKE IN THE MORNING feeling... *

WATER INTAKE *

CIGARETTES/VAPE? *

ALCOHOL CONSUMPTION *

EXERCISE *

WHAT IS ONE AREA OF MY LIFE THAT CAUSES STRESS *

GENERAL MESSAGE

BOOKING FORM

Let's Get Started