Consultation

1. Client Information

2. Emergency Contact Details

Emergency Contact (1)

Emergency Contact (2)

3. General Practitioner Details

4. Medical Questionnaire – Please Tick

5. Consent & Waiver

I, confirm that the information I have provided is true and complete to the best of my knowledge. I understand the nature, benefits and possible risks of Hijama (Cupping Therapy).

• I understand that Hijama may cause temporary redness, bruising, mild soreness, dizziness or itching.
• I understand that results may vary from person to person.
• I understand that it is my responsibility to inform the therapist of any changes in my health.
• I understand I can withdraw my consent at any time.
• I give consent for H&S Therapies to perform Hijama (Cupping Therapy) on me.

6. Treatment Record (For Therapist Use)

7. Cancellation & Appointment Policy

• A £5 booking deposit is required to secure your appointment.
• This deposit will be deducted from the cost of your treatment.
• The £5 deposit must be received at least 24 hours before your scheduled appointment.
• If the deposit has not been received, your appointment is not confirmed and H&S Therapies reserves the right to offer the appointment slot to another client.
• Cancellations made with less than 24 hours' notice, or failure to attend your appointment without notice, will result in the loss of your £5 booking deposit.
• Clients who repeatedly fail to attend appointments may be required to pay the full treatment fee in advance for future bookings.
• If you arrive late, your appointment may be shortened or rescheduled. In such cases, the £5 booking deposit may be forfeited.
• H&S Therapies reserves the right to reschedule appointments due to unforeseen circumstances. An alternative appointment will be offered as soon as possible.