Reflexology Client Consultation Form (Reproductive)
Are you:
Caution Check:
Have you received your Covid-19 vaccinations?
Was it on time?
What was the flow like?
Any Spotting (select all applicable)
Any Fertility Difficulties?
Previous or Current Fertility Treatment(s):
Do you or have you suffered from any of the following? (Please tick any that apply either currently or previously)
Have you been checked or previously treated for:
Contraception (please tick any of the following):
Are you currently taking any of the following? (Please tick any that apply)
Did You Suffer Any of The Following Ailments?