MW
Wellness With MajellaWexford sanctuary

New Client Intake

Wellness with Majella Consultation Form

A calmer way to complete your treatment intake before booking. This helps keep your first appointment safe, informed, and more personal.

Wellness with Majella logo

Wellness with Majella Consultation Form

Mobile-friendly intake form for safe treatment planning and insurance documentation.

Download Word (.docx)Download Google Docs text

Before you start

Set aside 5 to 10 minutes and complete the form in one go if possible.

Why it matters

Your answers help shape safe treatment planning and reduce repetition on arrival.

What happens next

Once submitted, the details can be reused during booking and stored for your appointment record.

Personal Information

Medical Information

Please indicate any of the following that apply to you.

Do you suffer from chronic pain?
Have you had any recent surgeries?

Massage Information

Have you had a professional massage before?
Do you have any allergies or sensitivities?
Are there any areas you do not want massaged?

Consent

I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time.

Form data is securely saved for treatment planning and can be reused during booking.