Maternity Form for Treatments, Coaching & Pregnancy Yoga

By submitting this form you agree to tell the therapist if there are any changes to any of the information in this or the supplemental forms.

Disclaimer: I accept that the information provided is a true and accurate reflection of my state of health. I give permission for treatment to be carried out. I have had each treatment explained to me and accept full responsibility. I will not change any medication I am taking without first consulting my medical practitioner and if I am taking anti-depressants I have my doctor's approval for treatment. I realise that my Dr Melanie Jones PhD is not a medical doctor, and cannot prescribe, diagnose or treat for a specific condition. . Reflexology for example can relieve tension which in turn helps to improve nerve and blood supply and to bring the body into balance. For Ear Reflexology I agree to remove the tourmaline balls 48 hours after treatment, leave them off for 48 hours and then re-apply more tourmaline balls. This application cycle can be continued until the issue has stabilised.