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    Consultation & Disclaimer Form

    1. Client & Treatment Details
    1.1 Therapist
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    1.2 Treatment Slot
    1.3 Full Name
    1.4 Treatments
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    1.5 Contact Number
    1.6 Email Address
    1.7 Age Category
    1.8 Date of Birth
    2. Parent / Guardian / Emergency Contact (if applicable)
    2.1 Name
    2.2 Contact
    2.3 Relationship
    3. Health & Screening
    3.1 Medical conditions / allergies *
    3.2 Current medications *
    3.3 Current status
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    3.4 Had this before?
    3.5 Skin sensitivity / past reactions
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    3.6 Recent sunburn / tanning (last 48 hrs) *
    3.7 Treatment area condition
    Select
    3.8 Pressure preference (Massage)
    Not Applicable
    3.9 Additional notes *

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