your contact details

all information is kept securely & confidentially, in line with current gdpr requirements. i will never share your details with a third party.

your pronouns

if you'd like to share, just so i know how you like to be addressed. your answer to these questions is always treated in confidence

email

phone

is this the address where the treatment will take place?

if no, please provide location address

which contact method do you prefer for follow-up?

about you

the information you provide is treated in confidence. it will help me to understand a little about you, your pregnancy journey & experiences & any important or current physical or lifestyle issues

about you

if you'd like to share what you do, what are your passions or anything to help me get to know you a little (no pressure!)

please share a little about what draws you to receive this massage?

all reasons are valid, if it's to address discomfort or simply to enjoy! this gives me a great insight into your expectations for the treatment!

have you previously or currently received massage, bodywork, or alternative therapies to support your pregnancy?

is there one thing you would most like to gain from this treatment?

your pregnancy history

your gp

please provide name of your current doctor (this is for insurance purpose)

how many weeks pregnant will you be at the time of the treatment?

how has your experience of pregnancy been so far?

feel free to share any discomforts, fears, worries, joys, feelings or experiences

in your current pregnancy, have you experienced any complications?

how do you plan to birth your baby?

any decisions for place of birth, support, techniques or hopes/desires

how are you feeling about giving birth?

have you received any fertility support or had previous issue with conceiving?

have you had previous pregnancies?

if yes, please share how many, dates and any relevant experiences

if relevant, please share your previous experience of pregnancy, labour, birth or postpartum...

have you experienced any pregnancy loss?

if yes, please kindly share when, the gestation and if this loss was miscarriage, stillbirth or chosen end of pregnancy

do you have any contraindications to receiving the treatment?

contraindications to pregnancy massage are; under 18 weeks gestation, a history of vaginal bleeding in pregnancy, experience of sudden, sharp pain in abdomen or pelvis, abdominal cramping or contractions, amniotic fluid leaking, any noted decrease in foetal movements

are you receiving any current medical care or taking medications or prescription?

if yes, please give details below

do you have any allergies

i will be using aromatherapy massage oils if there are any allergy concerns, please let me know.

if yes, please provide details below

please provide further details of any current or previous medical history below

your family history

are there any relevant family medical histories to note? such as cancer / stroke / mental health issues?

terms & conditions

please read the terms & conditions below & choose "yes" to confirm your booking

a booking does not constitute the creation of a contract and nama mama reserves the right to decline to process a booking for any reason whatsoever. if the booking is not able to be fulfilled nama mama will refund all monies. vat is not applicable. payment: please make payment in full upon booking. booking date: the date of the session will be agreed upon booking with a confirmation email. cancellation: if you wish to cancel your treatment for any reason please allow 3 working days prior to booking date to inform me. a full refund will be issued. nama mama reserves the right to amend or cancel any published prices. in the rare event that nama mama needs to cancel a booking, a full refund will be given. intellectual property: any recordings or written material included as part of this session are the sole property of the nama mama and may not be used or copied other than for the personal use of the participant without obtaining prior written permission from nama mama. data protection: the participant also agrees that nama mama shall hold your details on file and on computer and, in accordance with the data protection act 1998. you are able to view your individual file by giving not less than seven days written notice.

i have read & agree to the terms & conditions

how did you hear about nama mama?

pregnancy massage

booking form

thank you for choosing nama mama.

please fill in this booking form so that i have some details before we meet in order to make the most of our time & tailor the treatment to you.

should you have any questions about your treatment, please feel free to contact me at any time, i’m more than happy to have a chat - emma@namamama.uk

i look forward to meeting you soon! best wishes, emma xx

womb wellness sessions & alternative therapies to support menstruation, fertility, pregnancy, birth, postpartum & menopause

surrey, sussex & online