Ayurveda Consultation Registration
Thursday, 22nd February 2024 at Llanbradach Community Centre (All submitted data handled confidentially and according to our Privacy and GDPR Policies - email hello@thrivingcommunitiescic.org for a copy) PLEASE NOTE ALL SLOTS HAVE NOW BEEN TAKEN!!!!
Name
First Name
Last Name
Email
example@example.com
Mobile Number
Please enter a valid phone number.
Back
Next
Past Medical History
Any Current Health Concerns
Please list any current medications you are taking
Back
Next
You will be allocated a 15-minute time slot within the hour of your preference. Please choose your preference/s.
10.00am-11.00am (please note that these slots have now been filled)
11.00am-12.00pm (please note that these slots have now been filled)
12.00pm-1.00pm (please note that these slots have now been filled)
1.00pm-2.00pm (please note that these slots have now been filled)
2.00pm-3.00pm (please note that these slots have now been filled)
Please confirm that you agree to pay £10 for your 1:1 consultation in cash on the day
Please Select
I agree
Any Additional Comments
Submit Form
Should be Empty: