Your Name (required)

    Your Email (required)

    Your Telephone (required)

    Date of Birth

    Your Occupation


    Have you suffered from?

    Herniated / slipped spinal disk

    Risk of thrombosis (serious varicose veins, DVT)

    Advanced osteoporosis

    Replacement joints.

    Other, please specify


    Epilepsy or other nervous system disorder


    Dissociative disorders



    Further details

    For women only: Are you pregnant? Which trimester?

    Do you wear orthotics?

    Have you ever received steroid or cortisone injections?

    If yes how many and where?

    Health Details. Please include anything you are currently receiving treatment for or details of any medication you are taking:

    Goal Details: Please tell me about the things you would especially like to work on. What are your goals for these sessions?

    Do you feel that you are available and ready for change?

    *please read the general terms and conditions listed below and type I agree:



    Scheduling sessions

    One session of Pulsing should be enough for the Pulser to assess whether you as the client will benefit from continuing with the process and for you to have an idea of whether Pulsing will suit you. Is advisable to have at least three sessions, can be of great benefit even though we tend to address only the surface layers and most obvious strain patterns.


    • On the day with cash
    • Bank Transfers, to be paid before the session. Please request my bank details for this.

    Cancelation Policy

    Missed appointments will be charged at full fee if less than 24 hours notice is given.
    To avoid this unpleasant situation please notify me via telephone, text or email as soon as you know that you will be unable to turn up, if I can fill the space there will be no charge.

    What to Wear

    I want you to feel comfortable but equally it s important that I can see you and work so the following options are suggested:

    • Loose fitting cotton vest & shorts
    • Two piece swimwear (one piece will do for men!)

    Please DO NOT WEAR Bicycle shorts, panty girdles and other garments containing heavy elastic or lycra as they are impossible to work through.

    How you can help to get the most from your sessions

    Pulsing doesn’t force change – it invites it. In other words it is not a passive process, which is “done” to you but a joint effort between Pulser practitioner and client to explore new options and possibilities in an open and safe environment. It is important therefore that you be fully involved and committed to your process, trying to stay present during your sessions and making some effort to complete any homework suggestions between sessions.

    My Commitment

    I am committed to be fully supportive of their client’s process, during, between and for a reasonable time after treatment. I am therefore, always available to discuss any concerns, which come up for you as a result of the work and can also refer you on to another specialist if your issue is beyond my scope as a Pulsing bodywork therapist

    Safety, Confidentiality and Code of Ethics

    I am bound by a strict code of ethics and receive extensive training in how to ‘create a container in which change can happen’. This means creating an environment and working practice in which both me and the client can feel comfortable. This involves setting and maintaining clear and appropriate boundaries and ensuring that all client information is kept strictly confidential.


    Pulsing Bodywork is contraindicated for people with certain medical conditions. It is your responsibility to declare all medical conditions at the outset or obtain the consent of your doctor before being Pulse if you are unsure. In the unlikely event of a circumstance arising in which you are entitled to make a claim for damages against me, my public liability insurance is with: – Yoga Alliance Professionals.

    Consent to touch

    It is necessary for the Pulsing practitioner to touch your body in order to assist you in establishing balance and alignment. By agreeing to these terms & conditions it is understood that you give permission and consent for me your practitioner to do all that is necessary to achieve this aim, including but not limited to touching your body. This does not affect your rights to refuse or decline any part of the treatment, which you find uncomfortable or unacceptable.