Ear Candling Consultation Form

 

In order to provide you with the best care possible, please ensure that it has been 48 hours since oil was placed in your ear. Also, it helps to know if you have any of the following conditions or complications;
that I have answered the Consultation Form and I have not withheld any information that may affect the outcome of the treatment. The treatment has been fully explained to me and I am aware of possible side affects which may occur after treatment. There is no reason why I cannot have this treatment and it is my responsibility to inform my therapist of any changes that may affect my treatment either now or in the future.
Are you happy for me to securely store your Consultation Form ? The information will be held in the strictest of confidence and will not be shared with any third party unless explicit permission has been given by you to do so.  We respect your rights under GDPR.
For security verification, please enter any random two digit number. For example: 30
Reset Signature
If you can draw signature that would be good. Initials will do too !