top of page

Phone 021 1929 237

Home
About
Massage Treatments
Event & Corporate Massage
Gift Card
New Clients
FAQs
Contact
More

Use tab to navigate through the menu items.

new clients

client information form

First Name

Last Name

Mobile Number

Address

Occupation

Age

Please tick to indicate conditons (list A)

Allergies

Arthritis / Gout

Asthma / Breathing issues

Cancer

Chronic Pain Conditions

Diabetes

Digestive Problems

Dizziness

Easy Bruising

Please tick to indicate conditons (list B)

Epilepsy

Fatigue / Exhaustion

Fever / Flu / Viral Condition

Headaches / Migraines

Heart Condition / Chest Pain

Hepatitis A, B or C. HIV.

Hernia / Ulcer

High / Low Blood Pressure

Inflammation

Please tick to indicate conditons (list C)

Mental Illness

Numbness / Tingling

OOS / RSI

Pregnancy

Sleep Disturbance

Stroke

Swelling / Fluid Retention

Thrombosis / Blood Clots

Varicose Veins

If you answered yes to any of the above conditions, please provide further information.

Please tick to indicate any skin conditions

Rashes

Open wounds

Burns

Eczema

Fungal Conditions

Warts or Verrucas

Cold sores

Skin Ulcers

Do you wear Contact Lenses, glasses or heaing aids?

Please List any serious operations & serious injuries

Are you receiving any treatment or taking medication, please list.

If any of the above conditions are ticked a medical clearance from your GP or health practitioner may be necessary prior to your massage.

Doctors Name

Practice phone number

Are you currently experiencing any muscle tension, aches or pain? Please describe where.

I accept terms & conditionsView terms of use

Thank you for contacting us.

Phone

Patrice Murdoch

021 1929 237

Email

mandalamassaging@gmail.com

Mon - Sun: 9am – 8pm
We endeavor to be flexible, if your booking falls out of these hours, please send us a message

Hours

Address

For all our massage treatments we travel to your location, whether it be home, office or hotel etc. We are based in West Auckland and travel Auckland wide. There may be additional costs for travel outside our location perimeter.

bottom of page