"Natural Lift" Holistic Facial Massage

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Medical Details

GP Address

GP Surgery Phone number

Have you received Massage Therapy or any other Complementary or Holistic Therapies before?

If yes, what type of therapy, and (approximately) when was your last treatment?

Are you receiving treatment for any diagnosed conditions (from a GP, a Specialist, a Dentist or a Complementary Therapist)?

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Yes - pregnant for more than 3 months

No

Please tick to indicate which of the following apply to you (as many as are relevant).