775497991
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?
Was the Baby:
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Caution Check:
Have you received your Covid-19 vaccinations?
Upload File
Upload supported file (Max 15MB)
Have you had any of the following?
Have you been checked or previously treated for:
Are you currently taking any of the following? (Please tick any that apply)

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