Preparing for Your Session

Thank you for taking a few moments to complete this form before your Kahuna session.

Your responses help me gain a deeper understanding of your health, lifestyle and wellbeing, allowing me to tailor your experience to your individual needs. Everything you share is treated with respect and remains confidential.

I look forward to welcoming you soon.

– Nikki

About You

Full Name

Phone

Date of Birth

Day

Month

Year

Occupation

Emergency Contact

Emergency Contact Phone Number

Your Health

Your health history helps me tailor your Kahuna session safely and thoughtfully. Please let me know about any current or past conditions that may be relevant to your treatment.

Do you have any current injuries, pain or areas of discomfort?

Please include where you're experiencing discomfort and how long it has been present.

Have you had any recent surgeries, fractures or significant injuries?

Include anything you feel may be relevant to your treatment, even if you're unsure.

Do you have any diagnosed medical conditions?

This helps me tailor your session safely and appropriately.

Are you currently taking any medications or supplements ?

Please include any prescription medications, over-the-counter medicines or supplements you take regularly.

Is there anything else about your health that you'd like me to know before your session?

This may include pregnancy, allergies, recent illness or anything else you feel is important for me to know.

Do you have any allergies or sensitivities (for example, oils, fragrances or skin products)?

Please let me know about any allergies or sensitivities so I can tailor your treatment accordingly.

Emotional Wellbeing

Your emotional wellbeing can have a significant impact on how your body feels. You're welcome to share as much or as little as you feel comfortable with. Everything you share remains confidential.

Kahuna Bodywork is a holistic practice that honours the connection between the mind, body and spirit. I invite you to take a moment to reflect on anything you feel may be influencing your wellbeing at this time ?

This may include your physical health, emotional wellbeing, recent life experiences, stress, grief, or anything else you feel would be helpful for me to know before your session. Please take a moment to share anything you feel would help me better understand and support you during your session.

How have you been feeling in yourself lately?

Mostly calm and settled

Managing well despite life's challenges

Feeling stretched or under pressure

Feeling overwhelmed or emotionally depleted

It varies from day to day

If you could leave today's session feeling different in some way, what would that look like for you?

Lifestyle & Wellbeing

Your daily habits and lifestyle can have a significant influence on how your body feels and functions. The following questions help me gain a broader understanding of your overall wellbeing.

How would you describe your current activity levels ?

Very active

Moderately active

Lightly active

Mostly sedentary

How often do you take time to rest and recharge?

Regularly

Sometimes

Rarely

I find it difficult to slow down

What do you currently do to support your wellbeing?

This might include movement, meditation, time in nature, creative pursuits, counselling, breathwork, exercise, or anything else that supports you.

Is there anything that tends to make your pain, tension or overall wellbeing feel worse?

This might include stress, prolonged sitting or standing, certain movements, poor sleep, emotional stress, exercise, work, or other daily activities.

Have you noticed anything that helps you feel better?

For example: movement, massage, rest, heat, gentle exercise, time in nature, meditation, or simply slowing down.

Your Session

Kahuna Bodywork is different from traditional Western massage. Rather than focusing on isolated areas of pain or tension, Kahuna views the body as an interconnected whole. Each session is intuitively guided and tailored to support balance, restore flow, and encourage the body's natural capacity to heal.

The following questions will help me understand what has brought you here and how I can best support you during your session.

What has drawn you to Kahuna Bodywork at this time?

You may be seeking support for physical discomfort, stress, emotional wellbeing, recovery, relaxation, or simply creating space for yourself. Whatever has brought you here, I'd love to understand.

What would you love to receive from your Kahuna Bodywork session?

Whether you're seeking physical relief, deep relaxation, emotional balance, renewed energy, greater connection, or simply space to slow down, I'd love to understand what feels most important to you.

Is there anything you would like me to be mindful of during your session?

This may include recent injuries, health conditions, areas of sensitivity, personal preferences, previous experiences with massage or bodywork, or anything else you feel would help me support you safely and respectfully.

Is there anything else you'd like me to know before we begin?

This is an opportunity to share anything we haven't already covered that you feel is important for me to know before your session.

Thank you for taking the time to complete this form. Your responses help me create a safe, supportive and personalised Kahuna Bodywork experience. I look forward to welcoming you into the space.

Consent & Acknowledgement

I confirm that the information I have provided is true, complete and accurate to the best of my knowledge. I understand that withholding or providing false or misleading information may affect the safety and effectiveness of my treatment.

I understand that Kahuna Bodywork is a complementary therapy designed to support relaxation, wellbeing and the body's natural restorative processes. It is not intended to diagnose, treat, cure or prevent any medical condition and is not a substitute for medical advice or treatment from a qualified healthcare professional.

I understand that outcomes cannot be guaranteed and that each person's response to bodywork is unique.

I agree to inform Nikki of any changes to my health, medications, injuries, pregnancy status or other relevant circumstances before each session.

I understand that I may ask questions, modify or withdraw my consent at any time before or during my session.

I consent to receive Kahuna Bodywork and any complementary techniques that Nikki determines are appropriate within the scope of my session, based on my needs and the information I have provided.

I understand that my personal and health information will be collected, stored and managed in accordance with applicable privacy laws and used only for the purpose of providing my care and communicating with me regarding my appointments.