Booking Form
Please note, at the moment, we are not providing Ear Wax Microsuction or GP Services.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Are you an existing client?
*
Yes
No
Minor Surgery:
Mole Removal
Lipoma Removal
Sebaceous Cysts
Skin Tags Removal
Warts & Verruca
In-Growing Toe Nails
Joint Injection
Angioma
Milia Removal
Lumps & Bumps
Split Earlobe Repair
Xanthelasma
Please upload Image of area concern
Browse Files
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of
Aesthetic:
Laser Hair Removal
Laser Thread Vein
TheraClear Acne Treatment
Botox
Dermal Fillers
Profhilo
Radio-frequency Skin Tightening
Chemical Skin Peels
Dermapen - Microneedling
Medical Microdermabrasion
PRP Treatment
Anti-ageing Treatments
Skin Tightening
Blackheads
Jowls/ Sagging Skin
Acne Treatment
Hyperpigmentation
Scar Treatment
Age Spots
Neck Lines
Aesthetic Gynecology:
Vaginal Rejuvenation
Stress Incontinence
3D Lipo Treatment:
Body Fat Reduction
Fat Freezing
Would you like a FREE initial telephone/online consultation?
*
Yes
No
If so, when would be best to call?
Mornings
Afternoons
Evenings
Appointments
COVID-19 Screening
Do you have either:
a high temperature - This means you feel hot to touch on your chest or back (you do not need to measure your temperature)
*
Yes
No
a new, continuous cough - This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
*
Yes
No
a new, continuous cough - This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
*
Yes
No
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