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Siam Body & Soul

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Pre-Consultation form

Please fill out the following form to help us understand your physical condition.

Full Name

Email Address

Contact number

Date of Birth

Are you currently suffering from a medical condition, illness, or injury? if so please give details

Level of aches and pains

No stress

Low

Medium

High

Very high

Level of stress

No stress

Low

Medium

High

Very high

Reason for treatments

Any other conditions we should be informed?

By ticking this box I give permission for my data to be held by Saim Body & Soul and agree that the company may process data to me for offers, news letter, VIP invitations and manangement purposes

Thanks for submitting!

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Contraindication form

© 2022 by Siam Body and Soul

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