aromass. Questionnaire (EN)

Your name

How do I address you?

Email

Phone

Service

1 session (200₪)

Course - 5 sessions (900₪)

Course - 7 sessions (1200₪)

The first 8 questions are compulsory, the rest are optional.
You are advised to answer all questions. The more I learn about you, the better session you will have.

1. Do you have any chronic diseases?

2. Have you had any injuries or surgeries in the recent past?

3. are you allergic to any foods, flowers, animals, oils?

4. Do you have any current medical problems or pains that I should know about?

5. Do you have any diseases of the cardiovascular system?

Yes

No

6. Are you currently taking any medication?

Yes

No

7. Do you confirm that you are healthy and free of symptoms of illness (e.g. flu or acute respiratory infection) at the time of this questionnaire?

Yes

No

8. Do you have any skin problems?

9. How would you characterise your current emotional state?

10. Are there specific factors or events that could affect your emotional state (e.g., family responsibilities, personal problems, or other circumstances)?

Yes

No

11. How many hours per week do you devote to psychological or emotional support (e.g. psychotherapy, meditation, reading, etc.)?

12. What goal do you hope to achieve through massage?

13. What areas of the body need special attention?

14. What activities are usually associated with your work?

15. How many hours a week do you usually work?

16. How do you usually spend your free time and leisure time?

17. How much time do you usually devote to your hobbies and leisure activities per week?

18. Would you prefer a massage with musical accompaniment?

Yes

No

19. Which group of essential oils would you prefer?

Do you have any additional comments or observations regarding the massage session?

I confirm that I have provided accurate and complete information in this questionnaire.
I am aware that the massage therapist will be in constant communication with me during the massage and may request additional information.
I understand that the therapist will use this information to provide a comfortable, safe and effective massage session.
I understand that massage is a treatment that requires some preparation and intimacy and am willing to abide by the rules of behaviour and respect during the session.