Consultation Form

So that I can best serve you, we need to share the magnificent journey of your life.

The consultation form below is there to guide you in some of the aspects of your life I need to know. (It also helps to jog your memory).

You can fill this form in and send it to me online prior to your initial treatment, or we can go through it when we first meet up.

Do you currently have any of the following conditions?

Could you be pregnant? (If yes, how many weeks?):

Have you recently consumed alcohol? (within the last 5 hours):

Have you taken unprescribed drugs? (within the last month):

Do you take any prescribed drugs and/or supplements? Please list.

Have you any other medical conditions? Please share:

I, (the client) undertake to keep the therapist informed of any changes in my health and/or medication.

I confirm that I have understood the treatment that I am to receive and confirm that I am willing to proceed with/ without confirmation from my own GP or Consultant.  It is my responsibility and not that of the therapist to consult my GP or Consultant.

I hereby indemnify the therapist against any adverse reaction sustained as a result of the treatment.

Please note that scheduled sessions must be cancelled with a 24 hours notice, otherwise you maybe charged for the full session. 

Thanks for submitting!


Chris Brown

I had a series of reflexology treatments from Lisa which I found helpful for my general wellbeing as well as treating some specific issues. She has a caring approach and is attentive and supportive in her sessions. She has found a home in the healing arts.