Medical history

Please fill out the form below with as much detail as possible about your medical history. This is done for your own safety and to help tailor the session to your personal needs.

As with medical privacy, your medical history remains confidential.

Your details:

Medical History EN

Questions

Please answer the following questions.


Question 1


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Question 7

An indicative list of contagious diseases is available here.


Question 8


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Comments

Here, you can use free text to fill in anything else that you would like to mention:


File upload

Here, you can upload any additional data, diagnoses, medical reports or test results:


Instructions

You can download a copy of the instructions HERE.


Your statements

After you have verified that the information you have provided above is correct, please select the following checkboxes to confirm your agreement.