Before Your Visit

Consultation Form

A quick health and preference screening helps your therapist tailor every treatment safely to you. Fill this in any time before your visit — it takes about five minutes, and everything you share stays between you and your therapist.

Client Details

1. Treatment Requested

Select everything you would like today — final treatment is confirmed with your therapist.

2. General Health

Please answer honestly — this keeps your treatment safe for you.

Do you currently feel unwell or have a fever?
Are you pregnant or recently gave birth?
Have you had surgery in the last 6 months?
Are you taking any medication?
Do you have any allergies?
Do you have any medical condition we should know about?

3. Please Tick Any Condition That Applies to You

Heart & Circulation

Respiratory

Diabetes & Endocrine

Muscles, Bones & Joints

Skin Conditions

Neurological

Blood & Immune System

Other Conditions

4. Medications

5. Allergies

6. Areas to Avoid

7. Preferences

Confirm & Submit

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