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B Beautiful

Well-being

Health Questionnaire

Each section with a * next to the heading will need completing to be able to submit the form
If you are on a lot of medication you can bring me a repeat prescription list to keep in your records
Tick if apply to you*
Do you have any of the following? Please tick the ones relevant to you. You can add information about a condition in the next section.
Treatment consent
Please Read
I have read the information*
Covid Guidelines 2021
we are keeping strict safety policies in place to keep you and therapists as safe as possible. Please read
I have read the Covid information*
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This is a confidential health questionnaire that must be filled out by every client before treatment or therapy commences. Please answer the questions as fully as possible. 


It is important that you answer all questions the best you can to enable me to advise and assess your suitability for each therapy.

If you are unsure of any answers you can discuss with me by phone / text or email.


This information is for my use only and will not be given to a 3rd party . Your information will be stored under GDPR regulations


Just put your curser where you want to type and your keyboard should come up.

when finished press submit.