Registration form for appointments and classes

Thank you for taking your time to fill out the registration form below prior to attending your appointment or class.

Registration Form

Personal Details

Address *
Address
City
County
Postal Code

Private Insurance

NoYes

Insurance Details

I confirm that the information given is accurate and consent to be treated at TOPS. I consent to TOPS holding my data solely for the purpose of treatment and acknowledge that as part of my treatment certain communication will be required. I acknowledge that appointments cancelled with less than 24 hours’ notice may be subject to a charge.
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