Herbal Consultations Booking Form Name * First Name Last Name Chosen Pro Noun Age * Email * Phone Number * Consult options: * Please let me know where you would like to have your consultation Wowo Campsite, Wapsbourne Manor Farm, Sheffield Park About Balance in Brighton via skype/video call Do you require any particular access needs, language or hearing assistance, large print for emails and handouts? * Do you require an escort/friend/carer to accompany you? * Please choose which consultation you would like * Full length Mini consult (Acute issues only/skype often preferable) Preferred day of the week and time of day (Weekend consults are only available in the Winter months)? i.e after work hours only or Wednesday AM * Do you have any pre-existing medical diagnoses? * Please write a brief sentence on the need for a consultation and what you are seeking help with. * Are you taking any prescription meds? If so; what brands and dosage? * How did you find me? * Recommendation Google search Instagram Facebook Other Thank you for taking the time & energy to complete the Herbal Consultation form. I endeavour to reply to you within 24 hours, if it’s an emergency please contact me (Alice) on 07921 993497.Take care & I look forward to speaking with you soon. Alice
