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FACIAL CONSULTATION FORM

Medical Questions
Do you have any allergies or have you experienced any allergic reaction to medicine or products (such as latex, plaster, nickel, etc)?
Do you feel fit and well and able to have a procedure today?
Do you have or are you having any injectables or fillers?
Have you had a Dermaplaning treatment before?
Have you had an Acid Peel before?
Do you suffer from haemophilia?
Do you knowingly have any infectious diseases?
Do you knowingly have Hepatitis C?
Do you suffer from shingles?
Do you suffer from cold sores?
Do you take blood thinners or anti inflammatories?
Do you take Antabuse?
Do you take Roaccutane?
Do you have high or low blood pressure?
Are you currently taking any medication?
Do you have hypersensitive skin?
Do you have any skin abnormalities, ie eczema, psoriasis etc?
Do you have or have you suffered from rosacea?
DECLARATION

I understand the importance of my accurate and complete medical history and that withholding any medical conditions may be detrimental to my health and the outcome of the procedure.

 

I understand that I must adhere to the aftercare advice.

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I hereby give my written consent for Adele Hardcastle of The Skin & Brow Clinic to carry out the treatment of my choice.

 

By ticking below I agree to the above.

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