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Please fill out all of the below questions, prior to your appointment.

Contraindications (please tick where appropriate) 
Never treat unless the injury has been diagnosed and treatment has been recommedned by a medical practitioner.

Contraindications that restrict treatment (please tick where appropriate) 

Personal Information

Please tick or answer where appropriate

Muscular / Skeletal Problems:

Digestive Problems:


Nervous System:

Sports Details

Please tick or answer where appropriate

At what level do you participate?


Please read the following and tick the appropriate box, by ticking the box you are confirming you are in full agreement with the statements contents.

Client Information:

Parental Consent:

You should note that if the therapist is unable to explain to you the contraindications or is unsure of anything that may apply to a specific condition then they should not treat you without asking you to consult with your GP or Consultant. It is your responsibility and not that of the therapist to consult your GP or Consultant. *

Thank you for completing your consultaion form.

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