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Massage Treatment Certificate

NSW Remedial Massage

Shop 212, Level 2, 368 Sussex St, Sydney NSW 2000, Australia

ABN:19 104 038 745

Tel: 0422 786 924 | Email: info@nswremedialmassage.com.au

Date
Month
Day
Year

To whom it may concern,

Date of Birth :
Month
Day
Year

Has attended my clinic for Remedial Massage therapy on the following date(s):

Date of Treatment:
Month
Day
Year
Pain Level (0 = No Pain, 10 = Most severe)
The treatment was provided for the purpose of:

It is my professional opinion that this Treatment was necessary to assist whit the client's recovery and should be continued as required.

Therapist Details : Name: Thanud Siradulyakorn

Qualification : Remedial Massage Therapist

Provider Name: Thanud Siradulyakorn

Provider Number: MA8462R C182787 (BUPA)

Provider Number: A340251H (Medibank)

Provider Number: MA8462R

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Signature: Thanud Siradulyakorn

***Note: This certificate is issued for therapeutic purposes only and is not a substitute for medical advice or diagnosis.

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Located in Sydney CBD – Thai Remedial Massage using 2 thumbs only, no tools.  
Tel: 0422 786 924 

Email: info@nswremedialmassage.com.au  
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​ABN 19 104 038 745

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