Carers Week: Pamper Sessions

Carers Week: Pamper Sessions

at the Carers Centre, 1a Bank Street, FK1 1NB with Mary Philbin (The Treatment Room)
We are delighted to offer these pamper session to carers in Falkirk and Clackmannanshire as part of our Carers Week Activities.

Slots are limited to 1 appointment per carer, and are allocated on a first-come, first-served basis.

By completing this form, you are booking your appointment.

We would kindly ask if you can no longer attend, please let us know as soon as possible, so that we can offer your slot to another carer on the waiting/cancellation list.
Name:

First NameLast Name
Email Address:
example@example.com
Phone number:
Please let us know what treatment you'd like on the day. We just need to have a rough estimate to let Mary know. You may change your mind at any moment up to the point of your appointment.
25-min Pamper Appointment
Your Emergency Contact's Name
Your Emergency Contact's Phone Number
Please let us know about any allergies or health concerns that Mary should know about
Do you have any accessibility requirements?
Please indicate below if you are happy for photographs to be taken (except for massage) and shared with the funders and/or used on our Social Media platforms and in emails to promote future events.
MASSAGE/PAMPER THERAPY CONSENT FORM

I understand that the massage/pamper session I receive should not be construed as a substitute for medical examination, diagnosis or treatment. I understand that Mary Philbin @ The Treatment Room is not qualified to perform, diagnose, prescribe or treat any physical or mental illness and that nothing said in the course of the session given should be construed as such.

Your pamper session is purely to aid relaxation and enhance general well-being
Please inform Mary Philbin of any issues or concerns you may have prior to your session.
Signature
Date

DayMonthYear
Date
All information provided on this form will be treated as strictly confidential, kept securely and not shared without your consent or knowledge, except under exceptional circumstances. Full information about the information we collect and how it is treated is contained in our Privacy Notice which is from the Carers Centre and on our website.

Please see these links for further information about JotForm's privacy policy (https://www.jotform.com/privacy/) and how your information is stored (https://www.jotform.com/eu-safe-forms/).

Managed by Central Carers Association | Company Limited by Guarantee - Company No 184443 | Scottish Charity No SC023658
Should be Empty: