Online consultation form

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Please complete this form which covers your current health and wellbeing

First Name

Email Address

Last Name

Date of Birth

Are you taking any medications at the moment? *

No

Yes

Are you currently suffering from a medical condition, illness, or injury? *

No

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

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Blossom Sky Wellbeing, The Annex adj to Tailings End, Goongumpas, Crofthandy, St Day, Redruth, Cornwall, TR16 5JL

Contact Serena on 07812 199701,

Cancellations - any cancellations with less than 24 hours notice will be charged 50% of the treatment cost.

'No shows' will be charged 100% of the treatment cost.

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