JUNIPER BEAUTY ROOM

CONSULTATION FORM

Please complete the following Consultation Form and click the SEND button at the foot of the page prior to your visit with us.

Name *

First

Last

Email *

Contact Number *

Address *

Please give details and of any other relevant current health conditions we should know about prior to your treatment. *

Please give details of any skin conditions and allergies. *

I understand the importance of informing my therapist of all medical conditions and medications I am taking which may affect my treatment, and to let the therapist know about any changes to these at any future appointments. I understand that failure to do so may effect my treatment result. I agree for my details to be used by Juniper Beauty Room to contact me for appointment reminders, reschedules and availability and treatment offers that may be of interest to me. JUNIPER BEAUTY ROOM WILL NOT GIVE OUT ANY INFORMATION TO OTHER PARTIES. THESE DETAILS ARE FOR OUR RECORDS ONLY. *

I AGREE