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Help restore balance to your body, mind and spirit

Reflexology consultation form.


Please complete the following details before I arrive for your session.  The form can also be completed in person.

Have you been hospitalised in the last 12 months?
Are you suffering or have suffered from a medical condition, illness, or injury?
History or issues of any of the following?
Contra-indications - what you currenl have?

Thank you for submitting.

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