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GEMS HEBBERK CARE SERVICES

Registered BN-7452069 • We Really Care!

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💆‍♀️ Massage Therapy Intake Form

Complete this form before your first session. All information is confidential.

Full Name *

Date

Phone Number *

Date of Birth

Residential Address

Email

Medical Conditions

💰 MASSAGE PRICES:
🌸 Relaxing: N18,000/hr | ⚡ Stimulating: N20,000/hr | 🩺 Stroke Therapy: N100,000/month

🖊️ Client Signature

🧑‍⚕️ Caregiving Service Agreement

For Elderly Care, Child Care, and Home Support Services

Responsible Person *

Date

Address

Phone Number *

Alternate Phone

Services Required

👵 Elderly Care 👶 Child Care 🧹 Housekeeping

🖊️ Client Signature

Gems Hebberk Care

Professional home care, massage therapy, and wellness services.

BN-7452069

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Contact

📞 08108180001📱 08144951000💬 WhatsApp

📍 17 Oritshe Street, Ikeja, Lagos

© 2026 Gems Hebberk Care Services | Location is no barrier to our service!