NameFirstLast Daytime phone number Email If we were able to offer you a reflexology treatment do you feel you would you like to book an appointment?YesNoMaybe This does not commit you to an appointment. We appreciate personal circumstances and thoughts change, but it assists HRCC with calculating staffing levels required. Would you need any support getting into the Centre/Treatment Room? If so what can we do to help you?We have received guidance that we cannot offer treatments to anybody who is extremely vulnerable, or anybody living in the same household as a person who is extremely vulnerable. Please tick if any of these conditions are applicable to you or somebody in your household. Medical conditionsYou are undergoing active chemotherapy for cancer.You have lung cancer and are undergoing radical radiotherapy.You have cancer of the blood or bone marrow such as leukaemia, lymphoma or myeloma at any stage of treatment.You are having immunotherapy or other continuing antibody treatments for cancer. You are receiving targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors. You have had bone marrow or stem cell transplants in the last 6 months, or are still taking immunosuppression drugs.You have severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD).You have a rare disease that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell). You are on immunosuppression therapies sufficient to significantly increase risk of infection. You are pregnant with significant heart disease, congenital or acquired. You have been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. (GPs and hospital clinicians have been provided with guidance to support these decisions – please consult them should you not be sure of the situation.) If you have ticked yes to any of the above that relate to a course of treatment, when are you expecting that treatment to be completed? We understand that your needs may have changed and you may feel that you no longer wish to use our services at this time. If you wish to be removed from our current client list please tick the box below. Note: If you tick this box it would not prevent you from accessing our services in the future.Thank you for this information. If we are able to offer you an appointment we will be in touch soon.SubmitReset
