New Clients This form is for NEW clients only.For returning clients ... please use the button below. This form will allow us to gain the information we require to allow you to experience the maximum benefits of your time with us. Returning Clients New Clients Enquiry Form Please enable JavaScript in your browser to complete this form.First Name *Surname *Email *Telephone Number *Have you had Colon Hydrotherapy before? *Yes (please answer the next question)NoIf you have had Colon Hydrotherapy before, what sort was it?OpenClosedUnsureHave you had a Colonoscopy within the last 3 months? *YesNoHave you had any type of general surgery in the last 3 months? *YesNo Are you on any steroid-based medications or water restrictions? *YesNoAre you pregnant or given birth in the last 3 months? *YesNoHave you ever had any abdominal/pelvic/rectal or Colon Surgery in the last 3 months? *YesNoHave you ever been diagnosed with or do you suffer from any of the following? *Abdominal herniaAcute Liver failureAneurysm (all types)Cancer of the ColonCrohn’s DiseaseCardiac (Heart) conditionDialysis patientDiverticulitisFissures & FistulasHaemorrhoidsHaemorrhagingAny seizure disordersIntestinal PerforationLupusRenal insufficienciesUlcerative ColitisNone of theseBooking Preferences - Preferred timesMonday morningMonday AfternoonTuesday morningTuesday afternoonWednesday morningWednesday afternoonThursday morningThursday afternoonFriday morningFriday afternoonAny time is suitableDisclaimer *I have read the disclaimer and agree to the booking terms and conditions below.I understand Colon hydrotherapy is not intended to replace the relationship with your primary health care provider/s.I am aware there is a weight restriction of 150 Kg for the LIBBE device.Disclaimer and Booking Terms and Conditions “My consultation with a colon hydrotherapist is not intended as medical advice. I have not been diagnosed with any contraindications for colon hydrotherapy (above). I am aware that colon hydrotherapists are not physicians and therefore do not insert, diagnose or prescribe. I am aware this facility does not claim to or treat any condition or disease. I am aware that adverse events such as perforation, injury and illness have been alleged with the use of colonic irrigation and enema devices. I am responsible for the insertion of my rectal tube and for the flow of water. If I experience resistance during insertion of my rectal tube or any discomfort/pain during my treatment I will immediately stop my session. I am fully aware of the cancellation policy and agree that if I don't provide 24 hours notice for cancellations or reschedules that I will pay the advertised cancellation fee".Submit Our latest special offer - coming soon Book An Appointment