BWRT Appointment Form
Please complete the form in full, before we schedule an appointment. You will be sent my calendar from where you can choose a date/time to suit you. Please note, I work with over 18s only. Sessions are €120 for one hour, held online on Zoom.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Date of Birth
Occupation
Medical History (medications past and present, diagnoses past and present, etc), any heart or thyroid issues
What is it you would like help with? Can you tell me a bit about how you feel?
What treatments / therapies have you tried in the past, if any? How helpful were they?
Where did you hear about my services?
Submit
Should be Empty: