01787 278750 
07785 777014 


Please tell us as much as you can about your problem. When did it start? What symptoms do you have? Has it changed over time? Did anything happen which may have caused it? Is it linked to any other health issues you may have? 


Please give details of any other ongoing health issues you may have and any other medication taken 
High Blood Pressure
Heart Attacks


What stresses do you have at the moment / have you had in the last few years ? Please tell us about them below. 
Is there anything else you think would be useful for us to know? 
Radionics analysis and treatment uses methods and principles which are not necessarily recognised by the medical profession. The analysis aims to discover the basic causes underlying your symptoms so appropriate treatment can be given. Like other therapies Radionics cannot claim to be successful in every case. However experience over a number of years has shown it to be helpful in a wide variety of cases. The skills of the medical profession are recognised and you may be advised to consult your doctor. You are, of course, free to consult your doctor at any time. You are asked to regularly report any changes in your symptoms and all communications with you are kept strictly confidential. Parents and Guardians are reminded that “adequate medical aid” is required by law for children under 16 years of age which in practice means that the child is registered with a doctor. 
By returning this form you are confirming that you have read and accepted this notice and would like to receive Radionics treatment (a Parent or Guardian must do this on behalf of a child under the age of 16). 
Once you have submitted the form to us, please don’t forget to also send us a small piece of your hair, along with your name and date of birth to Smart Holistics, Elmhurst, 17 Pask Way, Clare, Sudbury, Suffolk CO10 8FJ. It would also be helpful to have a recent photo of you but, if you don’t have one to hand, that’s fine. 
The Initial Fee is now due and may be paid by cash, cheque made payable to “David Millington”, bank transfer — details on request — or credit / debit card via Paypal using the buttons on our site, www.smartholistics.co.uk. 
We will acknowledge safe receipt of your form and arrange a time to discuss the results of the initial analysis with you. Alternatively, if you prefer, we can send you an e mail instead. 
Ongoing Radionics treatment then commences on a month to month basis at a fee of £47 per month, payable monthly in advance. Where appropriate, advice will also be given of things you can do at home to help yourself. 
Treatment continues until you request that it stops. Where this occurs mid month, please note that there will be no refund of fees paid. If fees become overdue treatment will stop until payment in full is received. 
To ensure that Radionics is tailored to your particular needs, it’s important that you regularly update us on how you're progressing; every 7 to 10 days is ideal. However, if there are any changes in the meantime, acute illnesses (such as colds or coughs) or anything else that causes you concern; please do let us know. 
Our contact details are below. Please note that we do not offer an out of hours emergency service. 
By phone 
For all phone enquiries you can call us on  
01787 278750 or 07785 777014. 
If you do go through to voicemail please leave us a short message. Please note that both phones go onto the same voicemail, so you only need to leave a message once! We promise to call you back before the end of that working day. 
By text 
You can also send us a text to  
07785 777014. 
To avoid any confusion at this end please use "plain english" - rather than text speak (!) - and don't forget to include your name. 
By post  
If you would like to send us a letter please let us know beforehand and we'll give you the right address!