Treatment Consultation Form

Thank you for taking the time to complete this Consultation Form.  All information shared in this form is kept in the STRICTEST OF CONFIDENCE.

Reflexology is a holistic therapy. Through the application of steady, even pressure using specific thumb and finger techniques, reflexology connects with the peripheral nervous system and encourages the body to relax.  The Face mirrors the body and each reflex point connects with a specific organ, gland, body part, or body system.  Please be assured that the information that you give is completely confidential.

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Your Periods

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Hormone Diagnostic Information

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