Consultation
Please fill out your consultation form before your treatment
Full Name
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Address
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Telephone Number
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Email Address
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Date of Birth
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Occupation
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Your emergency contact
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Your emergency contact number
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Are you taking any medication
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Have you had any operation or illness within the last 3 month? *
Do you smoke? *
Do you exercise regular?
Have you had a back injury?
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?
(Female Only) Are you pregnant or trying to get pregnant? *
Allergies or dietary restriction *
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Do you have any cosmetics brand allergies? (Makeup or skincare)
Preferred contact method *
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