CONSULTATION FORM

First name

Phone Number

Last name

Date of Birth

Address

Do you have any known health issues and/or conditions that would impact your treatment

Yes

Are you have any allergies to any essential oil or nuts, carrier oils

Yes

If you answered yes to any question, please elaborate below and/or give a breif description of you desired outcome of your choosen treatment.

DATE

I declare that the info I’ve provided is accurate & complete. I agree i will inform my therapist of any discomfort at the time of the treatment so it can be altered accordingly. I understand that i will take full responsibility of any injuries or worsening of any conditions NOT stated on this form and detailed helth form presented at your booked appiontment and waiver the right to make any claim against the therapist. At the time of my treatment i will ensure personal hygiene is at a satisfactory level

Thanks for submitting!