Pregnancy Massage Reflexology Shiatsu Treatment Martha Wells Somerset Baby.jpg

Pregnancy Treatment FORM

If you are able to fill out this treatment form before our session then it would be great. If it is not possible then please don't worry at all, we can do this together when we meet.

Please also take note of my privacy policy, detailing why I need to collect your personal data, as well as how it is processed and protected. I am required to collect this personal data in order to do my job effectively and safely, providing you with the best possible treatment, advice and personalised teaching. I will not share this information with any 3rd party, unless required by the law to do so and do all that I can to keep it secure, at all times. My privacy policy sets this out in more detail.

If you have any questions at all then please do get in touch with me.

I look forward to meeting you.


Name *
Your babies due date? *
Your babies due date?
It would be great to know what you would love to get out of your sessions with me so that we can work together with that goal. This could be anything from deep relaxation to the treatment of an injury, and anything in-between.
Your job / stresses and strains / hobbies / diet / smoking / drinking / mood / support network (What is normal for you/has this changed?)
Please detail here any known or felt imbalances/conditions/injuries/operations/allergies etc
Would you be happy for me, on occasion, to send you information about the services that I offer? You may withdraw this consent at any time, to do so you can let me know by any convenient method, my contact details can be found on my website.