Confidential Client Questionnaire

All answers you provide are strictly confidential and will only be seen by Toni Miladinov.

In preparation for your first session please complete the relevant information with as much detail as possible. Take time to do it when you are relaxed, so that you remember and write anything that may be relevant to help you get the most from your session(s). All information and discussions are confidential and non-judgemental so please be honest. All sections are optional. Your details are used only for our work together. All paperwork is stored in a locked cabinet – no digital copies are kept. All paperwork is destroyed after the legal required period after your final session. Your contact details are for communication purposes only and will not be used for marketing or be made available to any third party.

Personal details

Family situation

Medical history

Do you have a Pace Maker?

Typical Diet

Medication

Have you ever reacted to any medication?

Do you drink alcohol?

Do you use recreational drugs?

If not, have you used recreational drugs in the past?

Do you smoke?

Please read the following statement: *

* Required

13 + 14 =

Cancellation Policy

Cancellations made later than 24 hours prior to the appointment will be charged at the full rate. Cancellation notice must be made in writing, either by email or text and confirmed by Toni that it has been received. If an appointment can be rescheduled to another time in the same week the penalty charge is waived. Appointments may be rescheduled with 24 hours prior notice.