Pre -screening Form
Please, fill the form. Fields marked with an * are required.
All information will be treated in the strictest of confidence.
I am sorry if the form looks too long. I need to know whether there is something that you need to consult with your GP or other medical professional before you start.
On the other hand, the more I know about you, the easier it is for me to create a personalized programme that really meets your needs.
I will contact you as soon as possible to give you an appointment with me.
If you have any questions, feel free to contact me.