REQUEST AN APPOINTMENT

Home – REQUEST AN APPOINTMENT

Thank you for choosing Newham Hijama for your Hijama cupping therapy.

To request an appointment, please complete the form below with the necessary details. Each individual interested in booking a session must submit a separate form.

Before your session, we will provide you with detailed guidelines on how to prepare for your Hijama therapy to ensure you receive the best possible care.

We appreciate your cooperation in filling out the form thoroughly.

Jazakum Allahu Khairan, and we look forward to assisting you.

APPOINTMENT REQUEST FORM

Full Name

Male / Female

Age

Religion

Sect

Mobile (Cell) Phone

Home Phone

Email Address

Postal Address

How did you hear about us

Have you had Hijamah done on yourself before

YES No

If yes, please provide details:

What are the main concerns or reasons that are making you consider Hijamah

Do you have any health conditions / sicknesses (Physical / Psychological)

YES No

If Yes, Please provide details about your Physical / Psychological health

Do you have or do you think you might have effect of any spiritual/supernatural issues (i.e. magic / Sihr, Jinn, Evil Eye etc)

YES No

If Yes, Please provide details about your spiritual health

Which days and timings are best for your schedule

Anything else that you want us to know

request-an-appointment

REQUEST AN APPOINTMENT

APPOINTMENT REQUEST FORM

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