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DERMAL FILLER FORM
ANTI WRINKLE FORM
When did you last have any aesthetic treatment?
I hereby consent to and authorise Aesthetic Coach Online to perform the following procedure:
Confidential medical questionnaire
Do you have any medical problems? (Asthma, diabetes, heart problems etc…)
Do you have any autoimmune conditions, cancers, blood disorders, neurological conditions, muscle disorders, facial problems or skin conditions? (Bells palsy, epilepsy etc…)
Are you currently under the care of a doctor, clinic, hospital or specialist?
Are you taking any medications? If so, which ones.
Are you allergic to anything? (Medications, latex, pollen etc…)
Are you or could you be pregnant, breastfeeding or undergoing IVF?
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