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FormWizard_v4

#London Aesthetics

Registration Form

Personal Information





Procedures (Please tick the procedures you are interested to discuss with Laser / Skin Doctor)

Unwanted Hair Removal With Laser
Aging Skin/ Face Lifting
Acne Treatment

Sagging Skin at Face or Tummy

Acne Scars

Weight Loss

Pigmentation on Face/Freckies Moles

Body Fats/Cellulite

Keloids/ Hypertrophic Scars

Stretch Marks

Skin Disease

Skin Whitening Treatment

Hair Loss/ Hair Fall

Botox/Derma Fillers

Prp Treatment/Carboxy Therapy

Pigmentation on Face/Freckies Moles

Cosmetic Surgery

Male Health

Female Health

Pain Management

Others






Do you have any general or medical allergies?

If yes please select




Other History




Do You Have Now or Have Ever Had Any of the Disease / Condition Listed Below?









Do You Ever Had Any Previous Medical(Non-Surgical) Cosmetic Treatments?










Agreement


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