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Before Your First Session

Just a few quick questions to help me prepare safely and make sure treatment is right for you.

First name*

Last name*

Birthday*

Day

Month

Year

Email*

Phone*

To help ensure treatment is safe and suitable for you, please let me know if any of the following apply. (If none apply, just tick "None of the above")

Do you currently have, or have you ever had, any of the following?

(Please tick any that apply — or leave blank if unsure)

Circulation & Heart

High blood pressure (uncontrolled or untreated)

History of blood clots or DVT

Heart condition (e.g. angina, irregular heartbeat)

Muscles, Bones & Joints

Recent surgery, fractures, or dislocations (within the last 6 months)

Joint replacements or surgical implants

Osteoporosis

Hernia

Nervous System & Sensation

Stroke or mini-stroke (TIA)

Epilepsy or seizures

Nerve damage or loss of sensation

Ongoing numbness, tingling, or unexplained weakness

Other Health Conditions

Diabetes

Cancer (past or present)

Blood thinning medication

Immune-related conditions (e.g. lupus, MS

Skin & Infection

Varicose veins (only matters if in the treatment area)

Skin conditions (e.g. eczema, psoriasis, wounds, infections)

Current fever or infection (cold, flu, etc.)

Pregnancy

Pregnancy or recently postnatal (please note: I do not treat during pregnancy)

Multi choice

Any other health conditions I should know about? (optional)

Long answer

Multi choice

None of the above apply to me

(If you’re not sure, feel free to leave the boxes blank and we can go over it together.)

Are you currently taking any regular medication?*

Yes

No

If yes, please list anything you'd like me to be aware of:

Do you have any allergies (oils, lotions, nuts, skin)?

Yes

No

If yes, please list anything you'd like me to be aware of:

What brings you in today?*

How did you hear about Muscle Health?

I was referred by someone

Google

Facebook

Instagram

Other

If you were referred, do you remember who by?

Before we go ahead, please take a moment to read and confirm the following.

Your information will always be treated with care and used only to support your treatment and appointments.

Please confirm the following:*

I understand that treatment may involve hands-on work and I can pause or stop at any time.

I've shared anything relevant about my health to help ensure treatment is safe and suitable.

I consent to receiving treatment from Craig Harley at Muscle Health.

I understand that my records will be kept securely in line with UK Data Protection Law.

May I contact you via email or text for appointment-related messages (e.g. confirmations, reminders)?*

Yes

No

Would you like to receive occasional updates or news from Muscle Health?*

Yes

No

Let's talk

I’m happy to answer any questions about treatment or help you figure out if a session is right for you.

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People from across Suffolk, Cambridgeshire and Essex often come to Muscle Health when they’re looking for focused, one-to-one therapy.

Craig Harley

Craig Harley

31 The Glebe

Haverhill, CB9 0DL

By appointment only

Email

Phone

Member of the Institute for Soft Tissue Therapists (ISRM)

craig.harley@musclehealth.uk

Clinic insured. One-to-one appointments in Haverhill.

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