Booking Form

Client Details and Authorization
Booking Form
Have you completed a consultation with The SAF Clinic before?
Appointment Calendar and Availability
Available Appointment Time
First Name
Surname
Gender?
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email Address
example@example.com
Phone Number
Mobile Number

Area CodePhone Number
Emergency Contact Name?
Emergency Phone Number
Emergency Contact Number
Please enter a valid phone number.Format: (+44) **** ******.
Have there been any changes to medical conditions, medication, allergies, recent injury, surgery, skin condition, etc., that your therapist needs to be informed about?
If you have selected yes, please specify what?
Medical Screening
Do you have any medical conditions? (Diabetes, Cancer, Anemia etc..)
Do you have any skin conditions? (Eczema, Psoriasis, Open Wounds etc..)
Do you have any allergies? (Nuts, Oils, Latex etc..)
Are you currently taking any medication?
Are you taking any blood thinners?
If you have selected yes for any of the questions above, please specify in more detail!
Treatment Selection and Appointment Preferences
Which treatment would you like?
Would you like to add Dry Needling for an additional £10?
If you have selected 'other,' please specify the treatment you would like, and we will contact you to address it.
Which treatment area would you like? (Please note you can only do one treatment area per session)
If you have selected 'other,' please specify the treatment area you would like, and we will contact you to address it.
Where will the appointment take place?
If you have selected Mobile Clinic please fill out the information below. If you have not selected mobile clinic please ignore this.
House Number
Street Address, Area, Town/City and Postcode

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
You will be contacted via WhatsApp regarding travel costs before your booking is confirmed.
How did you hear about us?

Other
If you have been referred by a friend, can you provide details (Full name and contact number)
Consent
Client Declaration & Consent

I confirm that I have read and understood the information provided about my treatment(s), including the benefits, risks, possible side effects, and aftercare advice. I confirm that the medical information I have provided is accurate to the best of my knowledge and that I have disclosed any relevant health conditions, medications, allergies, or injuries. I understand that treatments at The SAF Clinic are complementary therapies and do not replace medical advice or guarantee specific results. I voluntarily consent to treatment, understand that I may withdraw my consent or stop treatment at any time, and agree to the secure storage and use of my personal information in accordance with UK GDPR for treatment, record-keeping, and clinic communication.
Deposit

A £20 deposit is required to secure your appointment and is fully refundable if you cancel more than 24 hours before your scheduled appointment. Cancellations made within 24 hours of your appointment are non-refundable, and the £20 deposit will be retained.
Deposit to secure your booking!
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Deposit
£20 deposit to secure your appointment. Refundable with more than 24 hours’ notice; non-refundable within 24 hours.

£20.00
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Client Details and Authorization

Booking Form

Appointment Calendar and Availability

Medical Screening

Treatment Selection and Appointment Preferences

Consent

Deposit

Deposit to secure your booking!*

Deposit to secure your booking!