Confidential Client Consultation form

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Thank you for your response. ✨

Your name

Address:

Telephone:

Date of birth:

Occupation:

Doctor’s name and address:

Do you have any known medical conditions?

Are you taking any medication?

Do you have any allergies or sensitivities?

Have you had any recent surgeries, injuries, or medical treatments?

Could you be pregnant?

Are you currently experiencing any health concerns or conditions I should be aware of?

What would you like to get from your treatment?

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: e.g., nature sounds, lavender, etc

Please add any additional information you would like to add: