Consultation Form | Bare Lymphatics

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Consultation form

BEFORE YOUR APPOINTMENT

All new clients are required to complete a consultation form before their first session. Please fill this in as honestly as possible - everything is kept confidential.

Full name

Date of birth

Phone number

Email address

Treatment booked

Appointment date

How did you hear about us?

Are you currently taking any medications?

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Do you have any known allergies, particularly to oils or lotions?

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Have you had any recent surgery or medical procedure?

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Are you currently pregnant or postnatal?

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Do you have any of the contraindicated conditions listed above?

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Any other information you feel we should know?

I consent to before and after photographs being taken for the purpose of assessing results. These will not be shared publicly without my separate written permission.I confirm that the information provided is accurate and complete to the best of my knowledge.

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