Please enter your full name:
I am available for treatments on the following days (please select all that apply):
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
No preference
I am available for treatments between the following times (please select all that apply): 
Morning (10am-12pm)
Afternoon (12pm-3pm)
Late afternoon (3pm-5pm)
Evening (5pm-7pm)
No preference
I would like the length of my treatments to be:
1 hour
90 minutes
2 hours
Any of the above when suitable
I would like to recieve a treatment:
Weekly
Fortnightly
Once a month
Every 4-6 weeks
Every few months
Special occasion / once or twice a year
Whenever I feel like I need it!
Whatever is recommended by my therapist to promote my wellbeing and/or recovery
My main aim for recieving a massage is:
Relaxation
Self-care
Improve overall physical wellbeing
Regular maintenance for an specific area / injury / physical condition
Other
Please Specify :
Finally, is there anything that you would like to change/add to your treatments or the service provided by Shanthi Massage going forward?
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