Existing Client Ongoing Medical Consent

Send Email
Call Me Back
Enquire

Online Booking

Please consent to our data being processed in line with our privacy policy

Send Email

Name (required)

Email (required)

Phone (required)

Your Message (required)

Please consent to our data being processed in line with our privacy policy

Request Callback

Name (required)

Email (required)

Phone

When's best to call?

Please consent to our data being processed in line with our privacy policy

Existing Client Ongoing Medical Consent

Full name

Mobile

Email

Are there any changes in your medical circumstance? YesNo

Have you started any new medication? YesNo

Covid-19

Are you currently suspected of Covid symptoms? YesNo

Have you been in contact with someone suspected or confirmed of having Covid-19. YesNo

Recent Cough or any respiratory signs within the last 14 days YesNo

Fever/High Temperature within the last 14 days YesNo

Are you over 70 years? YesNo

This data may be held electronically by Cranwell House with your permission YesNo
I give Cranwell House permission to contact me by telephone or email YesNo

I certify that the information I have given is correct

Date

Scroll to top

WE ARE CLOSED!

After 15 years, Cranwell House has sadly closed its doors!

If you have any urgent queries please email [email protected] and we will endeavour to respond at our earliest convenience. We are unable to receive incoming calls but will be making contact with our clients.

OK