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CQC WF Test 2
CQC Workflow Test
All Portal Forms
Menu Tidy
Treatments
All Aesthetics Forms
All Massage Forms
All Facials Forms
All Eyebrow And Lashes
Members
Register
My Account
Member Login
Member LogOut
Member TOS Page
Public Individual Page
Subscription Plan
Lost Password
Form Demos
Form Builds
Login / Medical
Default Redirect Page
Thank You Page
Checkout Page
Massage Forms
Relaxation Massage
Please complete the form as best you can.
BBL - Massage - Relaxation Massage Screening Form
Any current injuries or areas of pain?
Yes
No
Details
Surgery in the last 6 months?
Yes
No
What and when
History of DVT, blood clots or clotting disorders?
Yes
No
We may need GP clearance before treatment. Our team will contact you
Varicose veins?
Yes
No
Any skin infections, rashes or open wounds?
Yes
No
Where
Are you pregnant?
Yes
No
Please book our pregnancy massage instead
High or low blood pressure?
High
Low
Heart condition or pacemaker?
Yes
No
Diabetes or reduced skin sensation?
Yes
No
Current or recent cancer treatment?
Yes
No
We may need clearance from your care team
Allergic to any oils, lotions or nuts?
Yes
No
Details
Any areas you would prefer not to be massaged
Pressure preference
- Select -
Light
Medium
Firm
Full
name
Date of birth
Date
Submit Form
Therapeutic Deep Tissue
Please complete the form as best you can.
BBL - Massage - Therapeutic Deep Tissue Massage Screening Form
What is the main problem you would like addressed?
Any current injuries, strains or areas of pain?
Yes
No
Where and how long?
Have you seen a GP, physio or osteopath about this?
Yes
No
Diagnosis or advice given
Surgery in the last 6 months?
Yes
No
What and when?
History of DVT, blood clots or clotting disorders?
Yes
No
We may need GP clearance. Our team will contact you
Taking blood thinners?
Yes
No
Which medication?
Osteoporosis or fragile bones?
Yes
No
Varicose veins?
Yes
No
Skin infections or open wounds?
Yes
No
Where?
Are you pregnant?
Yes
No
Please book our pregnancy massage instead
High or low blood pressure?
High
Low
Heart condition or pacemaker?
Yes
No
Diabetes or reduced sensation?
Yes
No
Recent cancer treatment?
Yes
No
We may need care team clearance
Allergic to oils, lotions or nuts?
Yes
No
Details
Full
Name
Date of Birth
Date
Submit Form
Pregnancy Massage
Please complete the form as best you can.
BBL - Massage - Pregnancy Massage Screening Form
Are you in the first trimester of pregnancy?
Yes
No
How many weeks pregnant are you?
Is this a high-risk pregnancy?
Yes
No
Details
Have you had any complications such as bleeding, pre-eclampsia, high blood pressure, or gestational diabetes?
Yes
No
Details
Has your midwife or doctor advised against massage?
Yes
No
Do you have any swelling in your legs, hands, or face?
Yes
No
Do you have a history of DVT or blood clots?
Yes
No
Do you have pelvic girdle pain or SPD?
Yes
No
Details
Do you have any skin conditions, rashes, or open wounds?
Yes
No
Where
Are you allergic to any oils, lotions, or nuts?
Yes
No
Details
Any areas to avoid
Pressure preference
- Select -
Light
Medium
Full
Name
Date of Birth
Date
Submit Form
Hot Stone Massage
Please complete the form as best you can.
BBL - Massage - Hot Stone Massage Screening Form
Any current injuries or areas of pain?
Yes
No
Details
Surgery in the last 6 months?
Yes
No
What and when
History of DVT, blood clots or clotting disorders?
Yes
No
Message
Diabetes?
Yes
No
Message
Any reduced skin sensation or numbness anywhere?
Yes
No
Where
High or low blood pressure?
Yes
No
Heart condition or pacemaker?
Yes
No
Are you pregnant?
Yes
No
Message
Varicose veins?
Yes
No
Skin infections, sunburn or open wounds?
Yes
No
Where
Do you overheat easily or faint in heat?
Yes
No
Allergic to oils, lotions or nuts?
Yes
No
Details
Any areas to avoid?
Full
Name
Date of Birth
Date
Submit Form
Sports Massage
Please complete the form as best you can.
BBL - Massage - Sports Massage Form
Create a screening form for sports massage
Yes
No
What sport or activity do you do and how often
What is the main issue or goal for this session
Any current injury?
Yes
No
Injury details
When did it happen
Is this injury being treated by a physio, GP or other professional?
Yes
No
Their advice or diagnosis
Any upcoming event or competition?
Yes
No
What and when
Surgery in the last 6 months?
Yes
No
What and when
History of DVT or clotting disorders?
Yes
No
We may need GP clearance. Our team will contact you
Taking blood thinners or anti-inflammatories?
Yes
No
Which medication
Osteoporosis?
Yes
No
Varicose veins?
Yes
No
Skin infections or open wounds?
Yes
No
Where
High or low blood pressure?
Yes
No
Heart condition?
Yes
No
Are you pregnant?
Yes
No
Please book our pregnancy massage instead
Allergic to oils or nuts?
Yes
No
Details
Full
Name
Date of Birth
Date
Submit Form
Lymphatic Drainage Massage Screening Form
Please complete the form as best you can.
BBL - Massage - Lymphatic Drainage Massage Screening Form
What surgery and date
Has your surgeon approved lymphatic massage?
How many weeks
Where
Details
What is your main reason for seeking lymphatic drainage
Full
name
Date of birth
Date
Submit Form
