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Face Sculpt & Fascia Release
Face Lymphatic Drainage Massage
Signature Face, Neck & Head Healing Therapy
Massage Treatments
Lymphatic Drainage Massage (Body)
Myofascial Release Therapy (Face & Upper Body)
Head Healing & Nourishing Oil Therapy
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Home
Treatments
Skin Treatment
The Boon Method Signature Facial
Signature Holistic Skin Reset Facial
Nervous System Reset Facial
Advanced Skin Renewal (Microneedling)
Skin Smooth & Glow (Dermaplaning Facial)
Skin Resurfacing Peel (Chemical Peel)
Face Sculpt & Fascia Release
Face Lymphatic Drainage Massage
Signature Face, Neck & Head Healing Therapy
Massage Treatments
Lymphatic Drainage Massage (Body)
Myofascial Release Therapy (Face & Upper Body)
Head Healing & Nourishing Oil Therapy
About Us
Reviews
Blog
Contact us
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Pre & Post-Operative Manual Lymphatic Drainage
Consultation, consent and treatment record.
Please complete this form before your appointment.
Client Details
Full name Date of birth Pronouns (optional)
Date of birth
Pronouns (optional)
Address
Mobile number
Email address
Emergency contact name
Emergency contact number
GP / medical practice
GP telephone (optional)
Appointment type
Pre-operative MLD
Post-operative MLD
Follow-up treatment
Main reason for attending / treatment goals
Communication And Accessibility
Do you need any assistance, reasonable adjustments or a chaperone?
Yes
No
Please provide details
Medical History
Heart condition or heart failure
High blood pressure
Low blood pressure
Kidney disease or reduced kidney function
Liver disease Diabetes
Thyroid disorder
Autoimmune or inflammatory condition
Current or previous cancer Deep vein thrombosis (DVT), pulmonary embolism or blood clot
Blood clotting or bleeding disorder Lymphoedema or chronic swelling
Recurrent cellulitis Current infection, fever or feeling unwell
Varicose veins or vascular condition Asthma or breathing condition
Neurological condition Epilepsy or seizures
Allergy or sensitivity Pregnant or breastfeeding
Pacemaker or implanted medical device Other significant condition
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