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Currently or during pregnancy have you suffered with any of the following conditions?

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If you answered yes to one or more questions, you must check with your doctor before taking part.

Please check the boxes below to confirm that you understand the following:

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I hereby confirm that the information stated above is answered to the best of my ability. I further fully understand that thorough and honest responses to these questions are essential to my safety. I undertake to inform my massage therpist  (Natasha Sahota) should any answers to the above information change.

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