MW
Wellness With MajellaWexford sanctuary

New Client Intake

Wellness With Majella Consultation Form

Complete your treatment intake before your first appointment, so your session can be planned safely around you.

Wellness With Majella logo

Wellness With Majella Consultation Form

Complete your intake here before your first treatment.

If you need an offline copy for accessibility or a special circumstance, please email majella@wellnesswithmajella.ie and one can be sent directly.

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

Your answers are kept with your appointment record and can be reused when you book.

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.

Your answers are stored securely with your appointment record.