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MEDICAL CONSULTATION FORM

The purpose of this consultation form is to assess your suitability for treatment and patient safety. This information will be securely stored for ten years and not shared with any third party.

PREVIOUS COSMETIC TREATMENT:

Have you had any previous cosmetic surgery (minor or major) under local or general anaesthetic?
Have you had any of the following? Botox, Dermal Fillers (temporary or permanent)?
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