Patient Registration

Data Protection

I consent to receive the following form of communication from Samira KM via:

Payment

Payments can be made by card or cash on the day of the treatment. If you wish to change or cancel your appointment please give 24hours notice. For cancellation or changes made with less than 24hours notice, or if you do not turn up for your appointment, you will be charged the full appointment fee.

Patient Declaration

I am happy to accept acupuncture treatment from Samira KM and I accept the cancellation policy above.