Medical Questionnaire

Please submit these online consultation forms prior to attending your first treatment. Please note that all details that you submit on these forms are kept strictly confidential.

Personal, health & lifestyle Details

I look forward to welcoming you at copper tree clinic

 

 


Please note: IF CLENT IS UNDER 16 years old, WRITTEN PERMISSION BY THEIR LEGAL GARDIAN IS REQUIRED BEFORE COMMENCING TREATMENT.

 For example:

As parent/guardian of- {name of client}

I confirm the above details are correct and give permission for her/him to have treatment-

Name of client`s parent/guardian-

Signature of parent/guardian-                                                           Date-

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