GDPR & Medical Consultation Form

We need information about your health in order to ensure that it is safe for us to provide the requested treatments.

Please state if you have / had any of the following
I have had surgery within the last 6 monthsI have had lymph nodes removed or radiatedI have a pacemaker or a heart or circulatory disorderI have had deep vein thrombosisI am currently breast feeding/pregnantI have allergiesI have an infectious diseaseI have a skin condition/open sore/woundI have a chest or breathing disorderI suffer from lymphedema, neuropathy or vascular disordersI suffer from epilepsyI often feel faint/dizzyI have suffered a recent fracture/muscular injury/metal pins or platesI suffer from backbone, or other muscle and/or joint disordersI am claustrophobicI am currently receiving medical treatment which I feel may affect my suitability for treatment

Are you happy to receive limited marketing communications from us?
I consent to marketing by postI consent to marketing by emailI consent to marketing by phoneI consent to marketing by SMS

Please add notes here that you would like your therapist to be made aware of: