• Client Consultation

    Personal details
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  • PLEASE ANSWER THE FOLLOWING HEALTH QUESTIONS

  • Are you prone to any of the following?

  • Please indicate are you or do you have any of the following

    *These require doctors consent
  • Sonophoresis Caution:

  • Have you been treated with any of the following?

  • Please indicate if you are having or have had any of the following

  • Declaration: This form including any additional data described above is an accurate reflection of my current health and discloses all relevant medical conditions.

  • Clear
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  • Should be Empty: