Intake form - The Neurodivergent Clinic

We need your address to send you supplements:

By signing this form, I agree to following Terms & Conditions:

• I agree to The Neurodivergent Clinic recording my health data as it's given by me at the time of my appointment or later in emails or other forms of communication.

• I understand that I will be contacted via email or SMS regarding my upcoming appointment and that it is my responsibility to ensure my fees are paid on time.

• I will endeavour to arrive in good time to my appointment, either online or in person, but acknowledge that The Neurodivergent Clinic is busy looking after complex needs clients, and sometimes my practitioner may be running late, as to ensure everyone gets the best care possible.

• Cancellations less than 24hrs prior to the appointment incur a fee.

• No-shows are charged the entire fee.

• I agree to accept the advice which my assigned practitioner will provide me during the course of our future appointments. If I am not content with the advice given in these appointments, I understand that I am free to seek the advice of another practitioner, at my own cost.