Search Results
34 results found
- Learn what Shiatsu Therapy can offer you, with ReikiEma in Cheshire,, Wigan, Greater Manchester, Lancashire and Merseyside.
Experience the healing power of Shiatsu at ReikiEma in Merseyside, Cheshire, Greater Manchester and Lancashire, UK. Discover Shiatsu with a student practitioner. About Shiatsu "The Art of Touch" “Shiatsu is a touch based therapy that applies pressure to areas of the surface of the body through loose comfortable clothing for the purpose of promoting and maintaining wellbeing. A Shiatsu practitioner will initially consult with the client and plan the Shiatsu treatment. The client will then be positioned comfortably, with appropriate adjustments being made throughout the session. Clear and accurate aftercare advice will be given. Shiatsu is a Japanese word that literally means finger pressure and derives its theoretical and practical roots from the ancient traditions of Oriental medicine. Today it is an autonomous treatment method influenced by Chinese, Japanese and Western knowledge. In addition to being regularly used by thousands of people all over the world, a variety of charities, health foundations, NHS trusts and hospitals in the United Kingdom provide Shiatsu to support patients whilst receiving treatment for a range of health issues and to help them maintain their general wellbeing. Complementary & Natural Healthcare Council What is Shiatsu? Welcome to ReikiEma, where I provide a range of holistic therapies to help you achieve balance and vitality. While many people associate Shiatsu with massage chairs and gadgets, it is actually a powerful and little-understood therapy that can have a profound impact on your health and well-being. Allow me to introduce you to this transformative therapy, today. Book now Shiatsu's Background Discover the ancient healing art of Shiatsu at my Holistic Therapy practice. Originating in Japan and rooted in Traditional Chinese Medicine, Shiatsu is a holistic approach to healing that focuses on the interconnected relationship between the body, mind, and spirit. With my expertise, you can release tension, reduce stress, and achieve overall balance in your life. Originating in Japan, with its roots in Traditional Chinese Medicine, Anma (an ancient form of Chinese massage similar to Tui Na, which was taken to Japan in the 10th Century CE.) The system of Anma was later developed as a profession for people who were blind; with Anma schools for the blind being founded across Japan - sighted people were banned from practising Anma! Book now In the 20th Century, Shiatsu was created as a healing modality, in its own right - making use of techniques from Anma, and other Japanese healing therapies, as well as the Traditional Chinese Medicine system of meridians and acupressure points in the body. Since its creation, Shiatsu has been developed and evolved to reflect many different approaches and techniques by different teachers and practitioners, and ranges from taking a Western/Eastern hybrid approach, though Zen Shiatsu, which uses extensions of the Classical Meridians, developed by a prominent teacher/practitioner in the 20th Century: Shizuko Masunaga . There is also "Seiki" - developed by one of Masunaga's top students, Akinobu Kishi . Seiki relies on "being" rather than "doing", more in the realm of the energetic and less on "working" meridians (not Reiki, but with many areas of communality). What connects all of these diverse schools of, and approaches to Shiatsu, are the therapeutic relationship between receiver and practitioner, the element of healing through touch, and the energetic connection between giver and receiver, which takes place during treatments. Book now What happens in a Shiatsu session? Shiatsu is highly adaptable, and can be tailored to people in most states of health and medical conditions. A Shiatsu treatment can be carried out with the receiver seated at a desk, lying on a treatment table, or (more traditionally) on a comfortable futon mat, on the floor. Book now Before a first treatment, the practitioner will often ask their client a fairly detailed set of questions around lifestyle, medical history and about the client's general picture of health and wellbeing. These questions help the practitioner to build up a picture of their client’s energetic picture, and any factors which are likely to be impacting on their overall holistic health and wellbeing. Some practitioners will ask to see a client’s tongue, as the Traditional Chinese Medicine technique of "tongue diagnosis" can be incorporated into Shiatsu; whereas some practitioners use observation of the client’s movements, speech, behaviour (what they say & do as well as how they say & do it) and any other outward signs of energetic or constitutional patterns – sometimes using the 5-elements/phases model as a framework. There will normally be a pre-treatment conversation, which usually covers asking the client which lying positions they are comfortable with, whether there are any areas they would prefer not to be worked on (some people are sensitive about their feet, for example), any symptoms present on that day, as well as giving the Shiatsu receiver the chance to decide/say what they would like to get from that day's treatment. After the pre-conversation, the client will be invited to lie down on the Shiatsu futon or treatment table (wearing comfortable, loose clothing, and having removed shoes and any chunky jewellery/watches/glasses), and offered a pillow and/or blanket/bolsters for additional support/comfort. Book now The Shiatsu practitioner often begins a treatment with “Hara diagnosis” – palpating areas of their client’s abdominal area, each of which correspond to a Traditional Chinese Medicine organ (reflexologists do the same). Hara Diagnosis offers the practitioner the chance to connect with their receiver's energy, to observe the relative qualities of energy in the different Chinese organs, and how they respond to the practitioner's own energy. Shiatsu practitioners will often use the information they pick up during Hara diagnosis, to decide which meridians will likely be their focus for the treatment - this is particularly the case with Zen Shiatsu practitioners. In the treatment itself, the practitioner uses hands (palming), thumbs (thumbing) and sometimes even knees, fore-arms and elbows, to work along the meridian lines (or energy channels) of their client’s body. Sometimes they will incorporate movement into the treatment, and include supported rotations, and/or stretches. Shiatsu practitioners are trained in safely and confidently moving amd supporting their clients’ legs, arms, heads, feet etc, and so if the client is able to completely relax and make their body as loose and floppy as possible, this is best for the treatment. "Helping” by doing the movement yourself actually means that you won’t get the full benefit of the movement – although this isn’t easy to (not) do for everybody, especially if you're new to Shiatsu - and your practitioner should understand if you find yourself not able to fully relax into being moved, straight away. Book now Book now What to expect after Shiatsu After a treatment, clients may feel a little light-headed or “spacey”, and so they’re encouraged to sit and drink some water or tea, and come back fully, before leaving after a Shiatsu session. Their practitioner will offer advice on ways to support their wellbeing (such as activities which will help support the work they have begun in the session, food energetics) and if the receiver has any questions, they are free to ask them – although as with Reiki and other energy-work modalities, the experience of the receiver is most important. It’s advisable to stay well hydrated after a Shiatsu treatment, to take things easy if possible. There may be a few aches and pains after Shiatsu, because it can be uncomfortable to re-establish a flow of energy where there may have been stagnation or deficiency - think about how it feels when the blood starts flowing to a hand or foot again, after circulation has been cut off for a while! The body can also sometimes go into a detoxification state, and some people feel a little under the weather because of this – they might have mild cold symptoms, or a minor headache, for example. This should only last for a day or two at most, and will only be very mild. Book now What does Shiatsu do? Each treatment will feel very different, and will do different things. What you need, and how you'll receive the maximum benefit on the day, depends upon your energy at the time of treatment. And one crucial thing you need to know about energy is that it doesn't stay still! It's always moving, changing and transforming. This is true of the energy around us, as well as the energy within our bodies and the energy that makes us, well, us! Some of the general overall outcomes intended by the practitioner for each Shiatsu session are: to help bring the person’s Qi into better balance; to promote the smooth, healthy flow of Qi through the meridians; and to help alleviate any aches, pains physical discomfort and symptoms which may be present. A Shiatsu treatment can be a deeply relaxing experience, a vigorous enlivening experience, a profoundly moving spiritual experience, and anything in-between! Shiatsu can help people to feel connected into their own bodies – and can bring a sense of peace and stillness. Some people describe it as "like going to church", others say it’s "like connecting into the Universe", and some people find it helps them to have moments of clarity and self-awareness about how they relate to the people in their lives and the world around them. It's probably fair to say that Shiatsu is not your standard massage! Book now How does Shiatsu work? Shiatsu makes use of the same energetic pathways (or Meridians) which Acupuncturists and Traditional Chinese Medicine practitioners use. Shiatsu is based on the foundations of Traditional Chinese Medicine theory, but many Shiatsu practitioners incorporate other elements into their treatments, as they evolve, learn and develop their practice. This is why it’s helpful to read reviews from other clients and also to talk to your practitioner before trying Shiatsu, to check whether their style and approach resonates for you. Energy work (as other forms of therapy) is always most successful when the client and practitioner’s energy resonate well with each other. Factors to consider are: how confident you feel in them and their skills, whether you feel they are compassionate (if that's what you prefer), whether their approach and way of expressing themselves feels right for you and whether you feel you just click. No matter how amazing a practitioner's skills and knowledge, you have to feel confident and safe with them, in order to reap the full benefits of the treatment. For more information about Shiatsu you can visit the Shiatsu Society (UK) or the CNHC ’s information about Shiatsu. Book now Shiatsu reviews Due to Ema massaging I have more flexibility in my joints less pain and a better understanding of my inner self and my thoughts Ema always takes time to listen to any problems you may be experiencing after my session my posture is so much better Ema is a lovely person Kate Neeson I have been receiving sessions with Ema over the last few months and I have to say they have been truly amazing. From start to finish each session has been a glorious experience. I have felt calmer, more inner peace and energised and much more focused. I highly recommend to anyone looking to improve your overall well being This was my fifth session and each one seems to get better. I was so relaxed during the session today that I nearly fell asleep. I came into the session feeling tired and stressed and left feeling calm, relaxed and energised. Booking my next session soon Shiatsu client at Juniper Clinic Phil Jordan
- ReikiEma | Reiki healing near you with a CNHC-registered professional
Unlock the power of Reiki near you with ReikiEma: (est. 2020). Ema is a CNHC registered, DBS-checked, qualified, highly experienced professional Reiki healer. Serving Cheshire, Merseyside, Lancashire and Greater Manchester. Experience Ema's caring approach to healing with: Reiki for Animals, Meditation, self-care shop, Natural Lift facial massage, womb & pregnancy massages, Shiatsu and Reiki. Book your session now and discover the meaning of wellbeing! Client testimonials available. Home: Image Subscribe to our newsletter • Don’t miss out! First name* Last name* Email* I'm interested in Holistic Therapies Courses, Blogs and Content Events Business contact Meditation Animal Reiki Business Networking with us Join I want to subscribe to your mailing list. Our Services Reiki "at home" treatment A Reiki treatment in the comfort of your own home Read More 1 hr 45 Brits pûn £ 45 Book Now Explore Plans Workshops & In-person Events What's happening In North-West England In-clinic and fully mobile treatments & services Book Online booking and appointment management Contact Us Reach Out 07521 125618 reikiema.therapy@gmail.com What our clients say Reiki Reiki Reiki Reiki Laura D Warrington Have had a few Reiki at home sessions now and so grateful that I was put in contact with Ema because it has been such a positive experience. Having tried Reiki before and not being sure about it, Ema has converted me and really enabled me to appreciate the benefits. Ema has also helped with lots of other advice and suggestions. Having treatment at home has been really helpful for me. I will be continuing sessions and would definitely recommend. Want to leave some feedback for us?
- Consultation Forms | ReikiEma
Consultation Forms for ReikiEma's new clients Complete the new client consultation form online in advance of your treatment, and cut out the hassle and faff on the day. Grab a brew and let's get this done! Pre-treatment Consultation Forms & New Client Information New Client Form (Reiki, Womb Massage & Shiatsu) "Natural Lift" Holistic Facial Massage - Client Form Pregnancy and Post-Natal Massage: Client Form Animal Reiki New Client Consent form Animal Reiki Terms & Conditions Under-16s Reiki Consent Form Terms & Conditions, and Client Code of Care
- Referral Landing Page | ReikiEma
https://static.wixstatic.com/media/7cafce_370971e2a0bb42209a67f25a5bf4c7e3%7Emv2.png Reiki Master Teacher Reiki Courses CNHC Reiki practitioner Animal Reiki Natural Lift facial Shiatsu massage Womb massage Pregnancy massage Meditation https://static.wixstatic.com/media/7cafce_1e380e6d99034f7d927697a7920778de~mv2.png The referral program is not available.
- Join our forum at ReikiEma.com and engage with like-minded souls. Share experiences, ask questions and get into fascinating and insightful conversations, outside of the therapy room!
Join the vibrant discussions on our forum. Connect with like-minded individuals at ReikiEma.com - working across Warrington, Lancashire, Cheshire, Wigan and St Helens UK. Share, learn, and grow together. Forum From questions about Reiki for Animals, to Reiki courses in Cheshire, to sharing experiences or perspectives on Wellbeing or Complementary Therapies - you're most welcome to join the conversation - or why not start your own?! To see this working, head to your live site. Categories All Posts My Posts Forum Welcome! Have a look around and join the discussions. Create New Post General Discussion Share stories, ideas, pictures and more! subcategory-list-item.views subcategory-list-item.posts 5 Follow Questions & Answers Get answers and share knowledge. subcategory-list-item.views subcategory-list-item.posts 0 Follow New Posts Swin Purple Aug 04 Reiki Shares General Discussion I attended the Reiki share in June and I have just registered for July and August too because it was excellent. I would like to recommend the shares. I had had a couple of Reiki treatments before but the share showed me how very versatile Reiki is and the group work really opened up the possibilities and power too. I felt much better afterwards and I really worked through some matters in my heart. I really hope people come and try it. The venue is very nice, easy to find and has free parking. Ema is excellent and knowledgeable and the event is incredibly good value for money. See you in July! Like 1 3 comments 3 Reiki Ema Jun 24 Reiki for Animals General Discussion Have you got any questions or experiences you'd like to share, about Reiki for Animals? I started sharing Reiki with my RSPCA foster cat, Tigger, during the Summer of 2020, and was blown away by how quickly it helped him de-escalate from anxiety and panic, and start to feel safe. I remember one time, sitting at the top of the stairs with him, giving him hands-off Reiki but directly for the first time, and at a certain point he just melted - rolled onto his back, purring and showing me his tummy, like a contented little kitten! After seeing how it helped his physical symptoms too (sensitive stomach) as well as his jumpiness and reactivity, I started to offer treatments to the animals at the RSPCA shelter Tigger came from. A few of the ways Reiki has helped rescue animals I've worked with Helps them to feel more relaxed Helps them to feel safe, and in a held, comfortable energy Helps them feel seen, connected with and understood Helps them to process and release trauma, worries, confusion and anxiety, in a safe, gentle way, at their own speed Empowers them to use the energy to heal in their own way, with no judgement, no expectation and no performance required from them. Have you got any questions about animal Reiki, or Reiki for shelter animals? If so, ask away on this forum! Volunteering with the RSPCA was an incredible learning experience for me - in all kinds of unexpected ways, and I believe it has helped my work as a Complementary Therapist for humans, as well as for my work in Reiki for Animals. Here's a link, if you'd like to book a treatment for your companion animal. And before you go, it'd be great to hear whether you know about or are interested in Reiki for Animals, in the Poll below, as well as on the forum! So go ahead and click below - as many options as are relevant to you. And if you want to join in the conversation on the forum, you're very welcome! Like 1 2 comments 2 Reiki Ema Mar 08, 2023 Welcome to the Forum General Discussion Share your thoughts. Feel free to add GIFs, videos, hashtags and more to your posts and comments. Get started by commenting below. Like 0 comments 0 Forum - Frameless
- ReikiEma's Clients' Testimonials
Discover heartwarming testimonials from satisfied clients of our holistic therapy services at ReikiEma across Merseyside, Greater Manchester, Lancashire and Cheshire, UK. See the impact of our work in these client testimonials! Wat myn kliïnten sizze ... Ema is professional, kind and incredibly knowledgeable. She really took her time to listen to my situation and needs, answer questions and explain things. She also sent valuable, follow-up information after the session tailored for my wellbeing. After the treatment I had a reduction in pain, which was what I had sought, but I also felt a whole body and mind benefit. I have already rebooked. Swin Purple, Burscough
- ReikiEma's Payment Plans and holistic treatment bundles.
Discover flexible great deals on holistic treatment bundles in the NW of England. We offer convenient payment plans and great offers at ReikiEma . Ema offers tailored plans and pricing to suit your needs. Plans and Pricing We've plans to suit every budget. Unlock savings and enjoy exclusive extras, by joining one of our plans, today. Are you thinking of gifting a Plan or a treatment bundle? If so, then you'll need an e-gift card ~ as our plans and bundles can't be transferred or shared. E-gift Cards Choose your pricing plan Mobile Wellbeing bundle £ 160 160£ Buy a course of sessions and get £5 off the cost of each Valid for 6 months Select 4 x 1-hour treatments (Mix & Match) 1 wellbeing-boosting meditation download VIP Gold Membership £ 120 120£ Every month Perfect for frequent/regular treatments Valid for 3 months Select Weekly treatments (Reiki or Shiatsu) Advance notice and discounts for events Free access to online recorded meditations 1 free gift voucher to gift a Shiatsu, Reiki or Animal Reiki Agile Membership £ 80 80£ Every month 2 treatments per month. Cancel whenever. Select 2 x Treatments per month Silver Membership £ 85 85£ Every month Perfect for regular/top up treatments Valid for 3 months Select 2 x 1-hour treatments per month Discounts on forthcoming events Gift voucher for 50% off a Reiki, Shiatsu or Animal Reiki. Annual Distance Reiki Pass £ 495 495£ Buy a year of monthly Reiki treatments, and use them at your own convenience: anytime, any place. Valid for one year Select 12 distance Reiki treatments A healing Reiki meditation download of your choice Distance Reiki Bundle of 3 £ 120 120£ 3 hours of distance Reiki treatments, whenever and wherever works for you! Valid for 12 months Select 3 hours of distance Reiki, from Ema 1 guided Reiki meditation download of your choice. Distance Reiki bundle of 5 £ 200 200£ 5 hours of distance Reiki, from Ema. Whenever, wherever! Valid for 12 months Select 5 hours' worth of distance Reiki treatments from Ema 1 guided meditation of your choice, to download Distance Animal Reiki bundle of 3 £ 120 120£ The gift of wellbeing for your companion animal. Valid for 12 months Select 3 x hours of Distance Animal Reiki Distance Animal Reiki - bundle of 6 £ 205 205£ 6 hours of Animal Reiki treatments Valid for one year Select 6 hours of distance Animal Reiki treatments 5 session package: Natural Lift Facial £ 225 225£ Optimise and maximise the rejuvenating benefits of our "Natural Lift" Facial Massage treatment Valid for 6 months Select Natural Lift Package Ultimate Uplift Plan £ 140 140£ Every month 12 weekly sessions - for maximum effect facial rejuvenation Valid for 3 months Select The Ultimate Uplift package (x12) In-clinic Wellbeing Bundle £ 180 180£ Pick & Mix from 4 of our most popular clinic treatments, and get £5 off each treatment! Valid for 6 months Select Reiki, Shiatsu, Womb massage, "Natural Lift" facial massage 5 Elements & You £ 1,99 1,99£ Every month Empower yourself with timeless wisdom and knowledge. Bring greater balance, harmony and inner resourcing to your everyday life. Enrich your holistic toolbox with this learning program 7 day free trial Start Free Trial Accessible Online Learning Programs (Automatic Registration) Membership in our Online Community (Automatic Registration)
- intake-form | ReikiEma
https://static.wixstatic.com/media/7cafce_370971e2a0bb42209a67f25a5bf4c7e3%7Emv2.png Reiki Master Teacher Reiki Courses CNHC Reiki practitioner Animal Reiki Natural Lift facial Shiatsu massage Womb massage Pregnancy massage Meditation https://static.wixstatic.com/media/7cafce_1e380e6d99034f7d927697a7920778de~mv2.png No form found. The link you used is missing a form ID.
- Pregnancy Post-Natal Massage Client Form | ReikiEma
Pregnancy and post-partum Massage New Client online form Pregnancy & Post-Natal Massage Client Form Pregnancy/Post-Natal Massage: Medical & Consent Form * First name * Last name * Date of Birth Day Month Month Year * Address * Phone Email * Emergency Contact: Name & relationship to you * Emergency Contact: Phone number (for us to phone/text) How did you hear about ReikiEma? Google Search Other Website Search Recommendation/Word of Mouth Social Media Other Yes, subscribe me to your newsletter. * Have you received Massage Therapy or Bodywork before (including before pregnancy)? Yes No Medical Details * GP Address * GP Surgery Phone number * Have you received Massage Therapy or any other Complementary or Holistic Therapies before? Past Complementary Therapies/Massage If yes, what type of therapy, and (approximately) when was your last treatment? Other therapies * Are you currently taking any Medication? Yes - prescribed Yes - not prescribed No * If you are taking any medications, please specify the name if you can, and what it's for. Medications info * Do you exercise? Yes No If you answered "yes" to the previous question, how many times per week, for how long, and what type(s) of exercise? Exercise info Please list and briefly describe any conditions or symptoms you have experienced, or are experiencing. * Any allergies or sensitivities * Have you had any serious or chronic illness, operations or traumatic accidents? Serious or chronic illness, surgery or traumatic accidents * Pre-natal Care Provider Pre-natal Care Provider info May I have permission to contact your Care Provider? * Due Date Day Month Month Year * This is my (number: 1st, 2nd etc) Pregnancy Pregnancy Number * This will be my (number: 1st, 2nd...) birth. Birth number * Please tick current problems. Anaemia Leaking Amniotic Fluid, or Vaginal Bleeding * Bladder infection * Uterine bleeding * Blood clot or phlebitis * Chronic hypertension * Abdominal Cramping * Diabetes (gestational or mellitus) Oedema/swelling Fatigue Headaches Insomnia High Blood Pressure * Leg cramps Miscarriage * Heartburn Nausea Problems with placenta * Pre-term labour * Pre-eclampsia (toxemia) * Sciatica Separation of the rectus muscles Separation of the symphysis pubis Skin disorders / athlete's foot Excess thirst Varicose Veins Visual disturbances * Previous caesarian birth Contagious conditions Muscle sprain/strain Heart attack/stroke Constipation Carpal Tunnel Syndrome Low Blood Pressure Morning sickness Anxiety, stress or mood swings Breathlessness Other conditions or problems in current or past pregnancy (please detail below) Anything else you would like me to know? (please detail below) Current pregnancy conditions and symptoms * Please tick any problems experienced in previous pregnancy(ies) Anaemia Leaking Amniotic Fluid, or Vaginal Bleeding Bladder infection Uterine bleeding Blood clot or phlebitis Chronic hypertension Abdominal Cramping Diabetes (gestational or mellitus) Oedema/swelling Fatigue Headaches Insomnia High Blood Pressure Leg cramps Miscarriage Heartburn Nausea Problems with placenta Pre-term labour Pre-eclampsia (toxemia) Sciatica Separation of the rectus muscles Separation of the symphysis pubis Skin disorders / athlete's foot Excess thirst Varicose Veins Visual disturbances Previous caesarian birth Contagious conditions Muscle sprain/strain Heart attack/stroke Constipation Carpal Tunnel Syndrome Low Blood Pressure Morning sickness Anxiety, stress or mood swings Breathlessness Other conditions or problems in current or past pregnancy (please detail below) Anything else you would like me to know? (please detail below) Previous pregnancy conditions and symptoms Further details on current/past pregnancy conditions/symptoms Further details on pregnancy conditions/symptoms I am experiencing a low risk/high risk pregnancy, according to my doctor/midwife. Disclaimer / Client Statement For my records, I need to confirm that you have read, understood and answered all of the previous questions. If there is anything you do not understand, or wish to ask about, please ask me now (before signing this statement). Otherwise, please read the following statement, and sign below to show that you agree. To the best of my knowledge, the information I have given in this form is true, and I have not withheld any information concerning my health. I will keep Ema Melanaphy updated on my health, should there be any changes to the answers already given. If I have, or develop any medical complications (marked with * in the list above) I will discuss the condition with my massage therapist, and will get a medical release signed by my pre-natal care provider, before continuing bodywork. * Client Signature Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload. Date Day Month Month Year Submit
- Natural Lift Client Form | ReikiEma
Ready to book your relaxing holistic facial massage? Don't forget to complete our online Natural Lift facial massage new client form before your first appointment. "Natural Lift" Pre-treatment Consultation Form "Natural Lift" Holistic Facial Massage * First name * Last name * Birthday Day Month Month Year * Address * Phone Email * Emergency Contact: Name & relationship to you * Emergency Contact: Phone number (for us to phone/text) How did you hear about ReikiEma? Google Search Other Website Search Recommendation/Word of Mouth Social Media Other Yes, subscribe me to your newsletter. Medical Details * GP Address * GP Surgery Phone number * Have you received Massage Therapy or any other Complementary or Holistic Therapies before? Past Complementary Therapies/Massage If yes, what type of therapy, and (approximately) when was your last treatment? Other therapies * Are you receiving treatment for any diagnosed conditions (from a GP, a Specialist, a Dentist or a Complementary Therapist)? * Are you currently prescribed and/or taking any medications (prescribed or not)? * Any allergies or sensitivities Any recent or planned surgery Any past major illnesses, surgeries, accidents or trauma? Any long-term symptoms or conditions * Are you pregnant or trying to get pregnant? Yes - trying Yes - pregnant for less than 3 months Yes - pregnant for more than 3 months No * Please tick to indicate which of the following apply to you (as many as are relevant). Diabetes High blood pressure Low blood pressure Thread veins Depressed immune system Eczema Psoriasis Heart condition(s) Blood condition(s) Cancer Osteoporosis Arthritis Undiagnosed pain Contagious illness (colds, flu, fever, throat or chest infection) Botox (in the last 6 weeks) Sunburn Asthma Trapped/pinched nerve Epilepsy Cysts or Warts Shingles Nervous system disfunction Whiplash Wearing contact lenses Recent operations Conjunctivitis Broken skin Cold sore(s) Skin rash Inflammation or swelling Highly sensitive/hyper-reactive skin Severe acne Severe bruising Infectious skin disorders None of the above Anything else you want me to be aware of? Disclaimer / Client Statement For my records, I need to confirm that you have read, understood and answered all of the previous questions. If there is anything you do not understand, or wish to ask about, please ask me now (before signing this statement). Otherwise, please read the following statement, and sign below to show that you agree. To the best of my knowledge, the information I have given in this form is true, and I have not withheld any information concerning my health. I will keep Ema Melanaphy updated on my health, should there be any changes to the answers already given. I understand there is a possibility I may experience some minor reactions as my body adjusts to the treatment. I understand that the therapist does not diagnose illness, disease or any other physical or mental condition. I understand that this treatment is not a substitute for medical examination, diagnosis or treatment. While I recognise that all due care will be taken by the therapist, I am aware that my participation in the treatment is voluntary. * Client Signature Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload. Date Day Month Month Year Submit










