This Consultation Form will assist your therapist in correctly evaluating your needs & to personalise your treatment for you today. All information is strictly confidential & remains the property of ZahMal London LTD.
♦ Please indicate any recent or current experience with any of the following:
Please list any other physical or health conditions that your therapist should be aware of:
Please list any medication taken regularly and any specific medication/pain killers taken today:
Please list any allergies:
Any notes or requirements?: