Health Declaration

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Full Name

ID Number

Date Of Birth

Please select the appropriate answer

Back problems / joint problems

Yes No

If so, please elaborate:

Blood Pressure:

High Low Normal

Migraines / headaches:

Yes No

Asthma:

Yes No

Fungal infection:

Yes No

Pregnancy:

Yes No

If the answer is yes, please indicate how many weeks pregnant are you.

Cancer:

Yes No

Allergies:

Yes No

Diabetes:

Yes No

Operations / fractures / accidents in the last year:

Yes No

If your answer is yes, please indicate:

Is there a place on your body that you would like us to focus on? Or if there is anything else about the treatment, you can indicate it here

Thank you for your cooperation

I declare that I am in good physical condition and do not suffer from any diseases, medical or otherwise, which may be affected by the treatment at Vasil Clinic. If I have consumed alcohol before or during my visit to Vasil’s clinic, I declare that I will not have any complaints and I will not prosecute the spa and its owners for any damage caused by intoxication.

By clicking "Agree", I confirm this declaration about the state of health and that all noted is true.

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Swedish Massage
Aromatherapy
Deep Tissue Massage
Orthopedic massage – Myofacial
Health Declaration
FAQ
About
Use of Cookies
Contact Us

Swedish Massage
Aromatherapy
Deep Tissue Massage
Orthopedic massage – Myofacial
Health Declaration
FAQ
About
Use of Cookies
Contact Us

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