By submitting this form I clearly state that I have answered all questions truthfully and to the best of my knowledge am in good health and able to receive my chosen treatment.
If on subsequent treatments any of your information has changed then please make me aware.
Your data will be stored securely by myself and not shared with any other third party for the duration of our relationship, in accordance with current data protection laws.
This data and any subsequent notes I make regarding our treatments will be provided to you upon request.
By submitting this form I agree to the above.