Initial Consultation Form - Louise Morgan

My initial consultation documents are now completed online. This form needs to be completed and submitted to me at least 24hours before your appointment or your appointment will need to be cancelled.

The consultation is so I know of any particular issues to be aware of for your therapy session. The information you provide will be submitted and sent to me by email. I will then add it to my secure client database and the information will be deleted from my email server. If you have any concerns regarding the information being provided, please send an email to contact@louise-morgan.co.uk with your concerns.

If I have any questions regarding your consultation form I will ask you on the day. Once submitted you will receive notification at the bottom of the page your form has been submitted.

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GDPR consent

I agree to your GDPR terms and conditions (These can be read at https://louise-morgan.co.uk/privacy-policy)

Name

First

Last

Phone number

Email

Address

Birthday

Occupation

Current medication including any self-prescribed

Do you have any allergies?

If yes, please provide details

Do you experience any headaches or migraines?

If yes, please provide details

Do you have any respiratory issues? (eg asthma)

Do you have any reproductive considerations? (eg hormone therapy, pregnancy, endometriosis etc)

Do you have sensitive skin?

If yes, please provide details

Do you have any autoimmune issues (eg lupus, ME etc)

If yes, please provide details

Do you have any digestive issues (eg IBS, IBD etc)

If yes, please provide details

Do you have any blood pressure or cardiovascular issues (eg high or low, implant etc)

If yes, please provide details

Do you have any mental health issues at the moment?

If yes, please provide details

Do you have any specific needs? (eg active consent throughout your therapy, accessibility considerations, vegan friendly products, gender neutral pronouns, neurodiverse considerations, religious considerations etc)

Anything else you need to tell your therapist? If so, please add details below

Please confirm

I agree

The information I have given is true and to the best of my knowledge. I hereby give consent to myself/my child being treated, and I will keep my therapist informed of any changes to my healthy while receiving holistic therapies with Louise Morgan

Name of person completing form

Name and relationship of adult if appointment is for a child under 16years

Newsletter

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Louise sends out a newsletter from Therapy Centre once a month, if you would like to receive it, please check the box