Please fill out the form below before your first treatment. It can take up 15-20 mins to fill out, luckily you only have to do it once, so that is good! Please fill it out as fully as possible as this information is required for your safety and to benefit your health, and can help inform your treatment(s). 


All your information on this form is confidential and your data will be protected. If you have any questions please let me know.

For questions that have lists of options e.g. normal/insomnia/ sleep too much/ .......please note down whichever options are relevant to you.

Thanks for submitting!

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