Client Consultation Form

Please complete our client consultation form before your treatment in line with our salon policy.

Full Name

Email

Phone

Address

GP Info

Prescribed Medication

Are you under a medical practitioner?

Do you have/had any of the following?

Eczema/ Dermatitis/ /Psoriasis/ Dry Skin

Varicose veins

Diabetes

Thyroid problems

Epilepsy

Heart condition

Fungal infection

Allergies of any type

Cancer

Muscular or back pain

High or low blood pressure

Other

If you have ticked any of the above, please give details:

I accept terms & conditions

Thanks for submitting!

Contact

07368 953617

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