CONSENT FORM

Do you suffer from or have you ever suffered from any of the following medical conditions?

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Diabetes

Migraines/headaches

Epilepsy

Kidney problems

Cancer

Stroke

Heart disease

High/low blood pressure

Asthma

Allergies

Sensitive skin

Varicose veins

Deep vein thrombosis

Injury to back or joints

Do you have any medical conditions or are you currently receiving any medical treatment? Yes/No (Please provide details below)

Are you currently taking any medication? Yes/No (Please provide details below)

Are you currently pregnant?

I confirm that the information given above is correct and complete. I agree to inform my therapist of any changes in my health/medical condition.

All bookings are subject to a minimum of 24 hr cancellation period. Any treatments cancelled after this time must be paid for in full.

Privacy Policy

This practice is committed to the privacy of its clients. Personal information is treated as confidential and used only for the purpose for which it was collected.