Due to the current restrictions, all patients must complete sections 1 and 3 of this form before attending the clinic for a treatment. Section 2 should be completed ONLY if you’re a new patient or if any of your details have changed.
Fields marked with an * are obligatory.
I will provide details for invoicing. I understand that I am liable for any excess payments, or for the full cost should the invoice remain unpaid after 60 days.
There may be a charge if less than 24 hours' notice of cancellation is given unless this is due to onset of fever.