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 £60

Existing patient appointments £50

Cash/Card Accepted

 

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Full address including postcode