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Birthday
Month
Day
Year

Please fill in the birthday the same as your Health Fund's record.

Do you want to fill out the Holistic Health Online Assessment before your appointment ?
YES, send me the link.
NO, I want to do it face-to-face on my Initial appointment
Do you give consent to REMEDIAL MASSAGE THERAPY?
YES
NO
Do you give consent to CUPPING THERAPY ?
YES
NO

May leave bruise like mark on you for days but not painful

Do you give consent to NEEDLING THERAPY?
YES
NO

Use Acupuncture needles to stimulate trigger points in muscles, which can feel like a sting and sore.

Do you give consent to AROMATHERAPY?
YES
YES, I need to list my allergies
NO
Other

Aromatherapy is a natural healing method that uses plant essential oils to support physical, emotional, and mental wellbeing.

Do you give consent to be in Social Media Video shooting?
YES
NO
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