Shiatsu new client form

Please complete the form below with as much information as you are comfortable with.

We will be in contact with you to organise a date and time for your treatment, and look forward to meeting you.

Name

First Name

Last Name

Mobile phone number

Email

DOB

Location

Occupation

Reason for booking a session

Have you had any major accidents/ injuries/ illnesses

When would you like a treatment - date/time