Client Booking Form

MEDICATIONS
Select any that you are taking/have taken within the last 6 months

WarfarinAspirinNurofenVitamin EFish OilRoaccutane (Isotretinoin)Vitamin A, Retin A or Renova (tretinoin)Antibiotics
Other Medications

PREVIOUS TREATMENT HISTORY
Select the ones that apply to you

Have had any Botulinum toxin type A treatments (Botox, Dysport or Xeomin)Have had any dermal filler treatments beforeHave had any permanent filler or facial threading treatments beforeHave had LED light therapy beforeHave had microdermabrasion beforeHave had IPL skin rejuvenation beforeHave had chemical peels beforeHave had laser resurfacing before
If you selected any of the treatments listed above, how long ago did you recieve selected treatments?

DISCLAIMERS

Information and Confidentiality
I agree that all information provided is true and have provided all information required to be able to proceed with treatments at GaBella Beauty. I understand that withholding any important medical information could result in beauty treatments going wrong/causing reactions and accept full responsibility if I have failed to provide all relevant information.

I understand that any information collected during my treatment and subsequent communications may be accessed by Gabrielle for the purpose of my on-going management.
GaBella Beauty is committed to protecting your privacy when collecting and handling your personal information.
I have read and agree to the stated disclaimers
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YOUR MEDICAL HISTORY