Medical History Questionnaire

PERSONAL DETAILS
MEDICAL HISTORY
Do you have or have you ever had any of the following conditions? (Please tick all that apply)
CONSENT & ACKNOWLEDGEMENT
I confirm that the information provided is accurate to the best of my knowledge. I understand that complementary therapies are not a substitute for medical treatment and that my therapist may advise me to seek medical advice if necessary.
I acknowledge that it is my responsibility to inform my therapist of any changes to my health or medical condition.
MARKETING & CONTACT CONSENT

Your information will be kept strictly confidential and will not be shared with any third parties. You can opt out at any time.

Thank you for completing this form. I look forward to supporting your health and well-being.

Sandra – BodySpiritMind