Consultation Form

Consultation Form

Please fill out this form and submit at least 3 days prior to your appointment. this form does take some time to fill in, but please take your time and fill it in full, as this will reduce time having to go through the questions in your appointment. Please be honest, I am here to help you and make appropriate recommendations. There are some questions that I appreciate are sensitive and personal, but I require the information to ensure that I modify treatments and recommendations to your scenario. Please note sub headings are idea of what to include in the free text fields, not specific lists of what to include. However, the more details you can provide, the better.

Please send any relevant test results, or cycle charts to eyrerachel@gmail.com. 

I understand that Rachel Dutton is not able to diagnose any conditions and that by receiving a treatment from her, I am not entering into a healthcare provider/patient relationship.

I also agree that payment is made in full at least a week before the session and that cancellation at less than 48 hours is non refundable