Consultation Form

Please complete & submit form to proceed with treatment

Your Name *

First

Last

Your Email *

GDPR CONSENT - Please select your preference below *

Yes, I would like to receive the quarterly newsletter email (including services & offers)
NO, I do not wish to receive emails from Ula Boyle

Your Date of Birth *

Please enter your date of birth using the format DDMMYYYY do not use spaces or symbols such as / or -

Your Address

Your Phone Number *

Are you currently under the care of a physician?

If 'Yes' - Please provide physician's name and contact number

Do you have any medical/health issues:

Any other information? Is there anything else you think I should be aware of before starting your session?

I declare that the information I have given is correct and I can undertake a healing session without any adverse side effects. I understand that Energy Healers do not diagnose conditions, and it is recommended that I see a registered medical/health care professional for any physical or psychological ailment I may have. I understand that energy healing is a non-invasive holistic healing/spiritual practice and does not replace medical care, but can complement any medical or psychological care I may be receiving. I am therefore willing to proceed with the session. *

Please select option

Date Form Completed - Please use the format DDMMYYYY *

Do not use spaces or symbols such as / or - as it may prevent the form submitting