Medical Consultation

Please fill in the form below, this is mandatory when attending an appointment. Please use the empty message box to include anything else you need to declare. 

    Heart/respiratory problems (thrombosis, phlebitis, hypertension, hypotension) Yes
    Kidney disorders Yes
    Circulatory disorders Yes
    Nervous conditions Yes
    Thyroid problems/Iodine allergies Yes
    Epilepsy Yes
    AIDS, HIV, Herpes Yes
    Cancer (diagnosed in the last 2 years) Yes
    Ingested Medications (eg. antibiotics) Yes
    Infectious skin disorders Yes
    Diabetes (Type 1/2) Yes
    Pregnant Yes
    Breastfeeding Yes
    Fever Yes
    Psoriasis Yes
    Claustrophobia Yes
    Eczema Yes
    Cold sores Yes
    Surgical scar tissues (in the last 12 months) Yes
    Sunburn/Prescribed exfoliants Yes
    Botox/Dermal fillers (in the last 12 months) Yes