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Consultation form

Allergies Asthmatic Cancer Diabetic type 1 Diabetic type 2 Epileptic Heart or Circulatory problems Hepatitis High blood pressure Low blood pressure Joint or muscular pain Kidney or Liver disorder Pregnant Breastfeeding IVF treatment Thyroid problems Varicose veins or Thrombosis

Your Permission - I certify that the above statements are true and correct. My clicking submit, constitutes my acknowledgement that I have read, fully understand and fully consent to the proposed treatment. I hereby give my consent and authorisation that release Thornton Hall Hotel and its agents of any claims that I have in the future in connection with the described treatment. I hereby consent to the use of my personal data (including sensitive personal data) for the purpose of my treatment and any further treatment and confirm that any treatment is at my own risk without limiting or affecting my own statutory rights I may have. I also agree to adhere to the measures in place relating to Covid-19. (Click here for details)


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