Request Appointment

1. Please choose your preferred appointment time from the calendar below,
2. Then scroll down to complete your contact details
3. Then click "Send Appointment Request".

 

   



Please scroll
 down to
complete
your
contact
details
My aims / goals for the therapy are  
If claiming a free treatment, please give the name of the client you have referred  
My name is  
My age is  
NB young people under the age of 18 will need parental consent
My email address is  
My house name / number is  
My postcode is  
My contact telephone number is  
Please give details of any existing medical conditions, or pregnancy - THIS IS IMPORTANT as it may be necessary for you to gain consent from your GP prior to receiving treatment. 1st Trimester of Pregnancy
 Asthma
 Depression
 Diabetes
 DVT
 Epilepsy
 Heart Disorder
 High or Low Blood Pressure
 Internal Bleeding
 Other - please describe below
If you are taking any medication at all please tell me what it is, and the condition being treated
Any additional information / queries, or a request for a  specific appointment time
How did you find my website?