• Consultation Form

    Consultation Form

  • Thank you for your booking and patience in completing this form!

    7 Market Place, Stockport, SK1 1EW (above the Warren and Still Life shops opposite St Mary's Church on Stockport market)

    Please call or text me when you arrive and I will come down for you 07903 162041 Zoe 

  • Terms and Conditions

  • Format: 00000 000000.
  • Date of Birth*
     - -
  • Do you have a physical disability or restricted mobility? please note the treatment room is on the 1st floor, up one flight of stairs*
  • Facials or Face Massage: Have you had Botox, Fillers or a Chemical Peel within the last 2 weeks?*

  • NOTE! it is not safe to have an electrical facial if you have a pacemaker, metal plates or pins. If you have any ear or body piercings please remove any metal jewellery before your treatment.

  • Are you vegan?*

  • Infectious Conditions

  • *I acknowledge that Revive has put in place preventative measures to reduce the spread of infectious conditions

    I attest that:
    *I do not have any infectious conditions and am not experiencing any symptoms.
    *I agree to cancel my appointment with Revive if I develop any infectious condition prior to my appointment. Your appointment will be rescheduled once free of charge

  • Please answer:*
  • I confirm that the health information provided is accurate. I understand that my records will be stored safely for 7 years past my final session in line with Revive Holistic and Beauty Therapies privacy policy and ABT insurance guidelines.*

  • Marketing Preferences

  • Do you agree for before and after photos to be taken and used for marketing purposes? Facials, Nails or Reflexology only*
  • Would you like to be added to our loyalty club email list?*

  • Revive Loyalty Club Details
    *Receive a 10% off any treatment voucher when you sign up
    *Earn 1 pt per £1 you spend. 100 points = £5 gift voucher for treatments
    *Earn 50 points when you refer a friend.
    *Exclusive offers and early access to special offers

    Your details will be held private and confidential and only used for our email newsletter or text message communications. Your details are only used to send occasional news and exclusive offers. Your details will never be sold or passed on to any other 3rd party company. You may choose to opt out at any time

  • Deposit*

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      £20.00£20.00
        
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    • Payment Methods

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      Choose from one of the PayPal options to make your payment.

      Contact Info

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