Booking Health Form

Fill out this secure form and we’ll get back to you as soon as possible.

Medical History

Do you currently have or have ever had any problems with the following? For those where you have ticked 'yes', please explain in the test box below, and for surgeries/treatments, please provide date of last surgery/treatment.

Please provide details and date of last treatment for all of the above that apply

Cosmetic History

Have you had or are you planning any of the following treatments? For those where you have ticked 'yes', please explain in the text box below.

Please provide details and date of last treatment for all of the above that apply

Other medical conditions:

Please list any medications you are currently taking:

Attachments:

Attach images of the relevant area in gif/png/jpg/jpeg format( size limit for each file: 15MB). (Note that this is a secure website and your photos will be treated with the strictest confidence, but we need at least one photograph in order to proceed.)

File 1:

File 2:

File 3:

Disclosure

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