Consultation
Please fill out your consultation form before your treatment
Full Name
Address
Telephone Number
Email Address
Date of Birth
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Occupation
Your emergency contact
Your emergency contact number
Are you taking any medication
Have you had any operation or illness within the last 3 month? *
Do you smoke? *
Do you exercise regular?
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Have you had a back injury?
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Do you suffer with tension/ stress? *
Cancer (within 5 years)? *
Do you suffer with leg swelling? *
Thrombosis / DVT (deep vein thrombosis? *
High / Low blood pressure? *
Are you aware of any circulatory problems such as cold hands or feet?
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(Female Only) Are you pregnant or trying to get pregnant? *
Allergies or dietary restriction *
Required
Do you have any cosmetics brand allergies? (Makeup or skincare)
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Preferred contact method *
Required
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