New Patient Questionnaire

Please find below my new patient health questionnaire in preparation of your appointment.  

I will go through these answers with you in clinic but it will save a bit of time if you could complete and return to me as a matter of urgency so that I can prepare your record card in advance of your appointment.

Please note that all your answers are held in the strictest of confidence and no one else, other than me, will see these answers.  All your details will be for my purpose only and to help you in clinic.  All data will be stored with your patient notes

If you don’t want to answer any questions then just make a note saying so in the answers. I just have to ask them. But if you’re not comfortable answering them then that’s your prerogative and I totally understand.

Any concerns or problems then please let me know.

The Clinic can be found at the following address:

Orchids Spa & Beauty Training Ltd
Lincomb Farm
Lincomb
Stourport-on-Severn
Worcestershire.
DY13 9RB

New patient appointments (approx 90 mins) – £150

 

dd/mm/yy
Full address including postcode

Please read, understand and check the box to agree you have read the full terms and conditions found on the link here Terms and Conditions

 

Here are a couple of the important points in regards to your appointment.

 

  • Please arrive 10 minutes before your appointment time
  • Any cancellations or changes made within 24 hours of your appointment time are charged at the standard rate
  • I send a confirmation message out the day before your appointment.  This is a simple reminder, not the point at which it is necessarily acceptable to cancel your appointment.
  • Confirmation of your new patient appointment is made once you have completed the form below, clicked submit, and made full payment for your first appointment on the following page.
  • All direct debit memberships monthly payments include a minimum term of 12 months.  If the direct debit is cancelled prior to the end of that 12 month period then full settlement for the remainder of the year is required.