Intake form

    Please take a moment to fill out our online consultation form before your visit. All information is kept completely confidential and is required for your safety and benefits your health.
    If you do not wish to complete this now, we can fill it out together at the start of your appointment.

    Would you like to receive any offers, appointments cancellations or any other notifications on a monthly basis?


    How would you overall health and well-being?
    How would you overall stress levels?

    For women, are you pregnant?

    Do you have any of the following in the last year? (please tick if yes)

    Privacy and sharing this information

    I understand that holistic therapies should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that the therapist is not qualified to diagnose, prescribe or treat any physical or mental health illness, and that nothing said in the course on the session should be construed as such. I affirm that I have answered all questions honestly and as far as I am aware , I can undertake the treatment , without any adverse effects.


    I have been fully informed and understand the procedure , benefits and contraindications for the treatment and any side effects which may occur and I am willing to proceed with the treatment. I understand I can say stop at any time of the treatment and the therapist will halt it.

    Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole that could have been filled by another client. As such we required a minimum of 24hs notice or any changes to your appointment.


    Clients who provides less than 24hs or absent to their appointment will miss the deposit done in advanced. Thank you for understanding.