Confidential Client Consultation form

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Your name

Address:

Telephone:

Date of birth:

Occuptaion:

Doctors name and address:

Do you have any known medical conditions?

Are you taking any medication?

Do you any allergies?

To make your session as comfortable and relaxing as possible, please let me know if you have any preferences or dislikes for sounds and aromas: Eg. Nature sounds, lavender etc

Please add any additional information you would like to add:

Any details and information that you provide are kept private and confidential, only I have access to them, and they are only used for the purpose of providing the best experience for you