This Consultation Form will assist your therapist in correctly evaluating your needs & choosing the correct treatment for you today. All information is strictly confidential & remains the property of ZahMal London LTD.
♦ Please indicate any recent or current experience of the following conditions:
Please list any physical or health conditions that your therapist should be aware of:
Please list any medication taken regularly and any specific medication/pain killers taken today:
What would you like to gain from your treatment today?:
Please note it is not advisable to have a treatment if you have a fever, cold or flu symptoms
How many forms have been completed
Our team is here to help you at every step.