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T visit to the doctor: GP Address: No. of children (if applicable): Date of last period (if applicable): Client Name: Address: Profession: Tel. No: Day Eve 40 50 50 60 60+ CONTRAINDICATIONS REQUIRING MEDICAL PERMISSION in circumstances where medical permission cannot be obtained clients must give their informed consent in writing prior to treatment (select if/where appropriate): Any recent injuries including fractures, strains, sprains, ruptures or tears Heart conditions or any hist.

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