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Vls Aesthetics Consent Medical Questionnaire

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VLS Aesthetics Consent Medical Questionnaire

Aesthetics practitioner pre treatment/consultation form

Page 1

Personal Information

Email*

Full Name*

Date of Birth*

Address*

Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Description:Fill out this VLS Aesthetics Consent & Medical Questionnaire before your treatment/consultation with our aesthetics practitioner. This form will help us understand your medical history and ensure that you are a good candidate for the treatment.

VLS Aesthetics Consent & Medical Questionnaire is a pre-treatment/consultation form that you need to fill out before visiting our aesthetics practitioner. This form is designed to help us understand your medical history, current medications, and any allergies you may have. By filling out this form, you will help us ensure that you are a good candidate for the treatment and that the treatment will be safe for you. The form includes questions about your medical history, current medications, allergies, and previous treatments. It also includes questions about your lifestyle, such as smoking and alcohol consumption, as these factors can affect the treatment. By providing us with accurate and complete information, you will help us provide you with the best possible care. Your privacy is important to us, and all information provided in this form will be kept confidential.

Full Name*

Phone Number*

Address*

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What is your child's date of birth?*

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