Health & Consent Form

A quick health and consent form to help Ellie plan a treatment that's safe and suited to you — not a liability waiver. Everything you share here is kept confidential and used only to assess treatment suitability.

Your details

Please complete this before your first appointment. If anything changes before then, just let Ellie know.

Full name

Phone number

Date

Allergies

Nut allergy

Coconut

Specific oils / fragrances

Plasters / latex

Other

Allergy details (optional)

Medical conditions

High blood pressure

Low blood pressure

Heart condition

Diabetes

Circulatory issues

Skin conditions

Recent surgery

Epilepsy

Cancer / oncology care

Other

Condition details (optional)

Current medications

Pregnancy

Yes

If yes, how many weeks?

Injuries / areas to avoid

Recent illness or surgery

Consent & declaration

Ellie uses the information above to assess whether a treatment is safe and suitable for you. She can only take into account what's shared here, so she can't be held responsible for a reaction or issue relating to something relevant that wasn't disclosed.

This information is used only to assess treatment suitability and is kept confidential.

I confirm the information I've given is true and complete to the best of my knowledge, and I'll let Ellie know before treatment if anything changes.

This is a health and consent form, not a liability waiver — it simply helps Ellie plan a treatment that's safe and right for you.

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Fully Insured DBS Checked

Terms: Bookings are confirmed by Ellie directly. Please give 48 hours' notice to cancel or rearrange — late cancellations and missed appointments may be charged in full. A health form is required before your first treatment. Full terms → Terms & Conditions

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