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Consultation Form

Please fill out the following form.

Date of birth
Use acne medication (oral/topical)
No
Yes
Do you use Retinols?
No
Yes
Do you use Alpha Hydroxy Acids?
No
Yes
Do you use Accutane?
No
Yes
Do you use Blood thinners?
No
Yes
Are you Diabetic?
No
Yes
Have you been waxed before?
No
Yes
Do you have Epilepsy?
No
Yes
Do you have any new scar tissues?
No
Yes
Are you pregnant?
No
Yes
Any undiagnosed lump or bumps?
No
Yes
Do you have Oedema?
No
Yes
Do you have Varicose Veins?
No
Yes
Do you have Psoriasis?
No
Yes
Do you have any skin disease?
No
Yes
Are you on any prescribed medication?
No
Yes
Do you have allergies?
No
Yes
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