SB Physiotherapy & Pilates

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SB Physiotherapy & Pilates

Book in with Sinéad

Please fill out the form below, including which service you require.

Select Service

First Name

Last Name

Date of Birth

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Your Address

Email Address

Telephone Number

GP Name & Address

Please describe your problem/injury you are looking help with

What is it preventing you from doing/what movements are causing discomfort?

When did your problem start?

Have you had any form of therapy or treatment for this particular problem?

Yes

Do you have any of the symptoms listed: Bladder/bowel dysfunction, numbness around saddle area (buttocks, perineum, groin), loss in sensation and/or inability to use lower/upper limbs, history of cancer, immunosuppression, night pain or history of recent trauma?

Current Medical History (Surgery, Conditions, Inclusive of pregnancy & stage)

Current medication

Any allergies?

Injury history (No matter if you think they are insignificant i.e. Sprained ankle in 2002)

By submitting this form I consent to the general T&Cs and specifically consent to undertake online assessment and treatment guided by Sinéad Boyle, Chartered Physiotherapist

I Consent

By ticking this box, I agree Sinead can contact me via email regarding bookings, future classes and ongoing promotions

I Agree