Client Details Form

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Client Details Form

All new clients to complete this form as much as possible in advance of your appointment.

Title

First Name

Surname

Home Telephone Number

Mobile Telephone Number

Address

Postcode

Email Address

Date of Birth

YYYY

Age

Add to mailing list *

Yes

Option 1

Clear selection

Client Privacy Policy

I take your privacy seriously and will only use your personal information to assist me to provide the products and services you have requested from me.
I will keep paper records of your sessions and recommendations made. Any records I hold will be shredded once they have been inactive for 6 years or earlier at your request. You can request access to any information I hold at anytime.

All paper records are securely kept under my sole control and all digital information is password protected.

Email and Text message reminders will be sent direct from 10to8.com.

If you consent to me passing on your details for that purpose please confirm:

I agree

I disagree

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Mailing List

From time to time I would like to contact you with details of other events and offers I provide. Some emails will be sent via Mail Chimp with the option to opt out at anytime.

If you consent to me contacting you for this purpose please tick below:

I agree

I disagree

Text Message

Clear selection

Opt Out

If you decide to opt out in the future you can easily opt out by contacting me.
Email karen@karensinfinitehealth.co.uk or by texting or calling me on 07762054818.

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