your treatment

upon receipt of your booking form i will send a confirmation email to confirm the date for your treatment with payment link - please note your booking is not confirmed until payment is received.

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?

tell me about you

the information you provide is treated in confidence. it will help me to understand a little bit about you, your journey & experiences, where you are in your life right now & 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 treatment/bodywork?

all reasons are valid, there is no right or wrong! this gives me a great insight into your connection to the treatment

have you previously or currently received womb massage, bodywork, or alternative therapies?

please provide any relevant details & how you feel you benefitted (or not!) from your treatments

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

your medical history

your gp

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

do you have any contraindications to receiving the treatment?

if know you are pregnant or you there is a possibility of pregnancy this is contraindicated. if you are menstruating this is also a contraindication to areas of the womb massage, please select "yes" and give details below

if you have your period or are trying to conceive at the time of treatment please detail below

it is not advisable to massage the lower abdomen if you are menstruating or are actively trying to conceive & may be pregnant or in your ovulation phase. treatment can be given just excluding lower womb massage, please indicate below, if not applicable please delete.

are you receiving any current medical care?

if yes, please give details below

are you currently taking any medications or prescription?

if yes, please provide 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?

your menstrual & reproductive wellness

at what age did you start menstruating?

please add any details about how you felt physically or emotionally when you began your period

how would you describe your current relationship with your womb and/or menstrual cycle?

do you know the date of your last period?

how long is your menstrual cycle?

the average number of days from the 1st day of your period (when you start to bleed) to the 1st day of your next period

do you currently chart your menstrual cycle?

have you had any episodes of amenorrhoea (missed periods) other than pregnancy or breastfeeding?

if yes, please indicate when this happened

share any further details below

your uterine health

please share any further details below

your fertility experiences

please use this space to share about any fertility issues past or current

fertility treatment

if you are currently undergoing fertility treatment, please share details below

your birth or pregnancy experiences

please use this space to share any pregnancy or birth experiences, including any miscarriage or loss

do you have regular cervical smear tests?

how would you describe your current interest in sexual interaction

please share any thoughts about your relationship with your sexuality

are you comfortable with your current sexual desire or activity? do you have any history that makes it difficult for you to connect with your sexual self? there is no requirement to share anything here, if you'd like to we can talk in person, please write "happy to share in person" or leave blank, all details treated in strictest confidence.

your menopause

if relevant to you, please show where you are in your menopause journey

are these symptoms changing?

are you receiving hormonal replacement therapy?

are you using any alternative therapies for your menopause?

please describe any treatments, supplements or herbal remedies

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 has been agreed upon booking. if booking a closing and you are currently pregnant allowing for flexibility for your birthing time to change! please let me know once your baby is born if you need to make any changes to the booking date & we will reconfirm. 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.

if you had a caesarean birth or had an episiotomy/tear during birth, please confirm you will be 6/8weeks post birth when the treatment takes place?

there should be a 6/8 week period for the necessary healing to take place within the muscle layer before receiving a massage after caesarean birth or episiotomy/vaginal tearing.

i have read & agree to the terms & conditions

how did you hear about nama mama?

new client

booking form

new client

booking form

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

surrey, sussex & online