Treatment as a model
Join the database for treatment at one of our training centres, applicants must be over the age of eighteen.
Name
*
First Name
Last Name
Date of Birth
*
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Month
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Day
Year
Date
Address
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House name or number
Street Address
Town/ City
County
Post code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Location
Newcastle
London
Tamworth
Please tick the treatments you would like to be considered for
Botulinum toxin upper face
Botulinum toxin hyperhidrosis ( under arm sweating)
Dermal fillers mid face cheeks nose to mouth lines
Dermal fillers lips and perioral area
Dermal fillers tear trough and periocular area
Dermal filler non surgical rhinoplasty
PDO Thread lift
Please upload your photos
*
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Tell use about your medical history, do you have any of the following conditions?
Heart disease
Liver or renal disease
Auto-immune disease
Asthma or COPD
Cancer
Thyroid disorder
Epilepsy seizures or convulsions
Diabetes
Skin disorders, acne, dermatitis, eczema
Hepatitis or HIV
Depression or anxiety
Females, are you pregnant or trying to conceive?
Do you take anticoagulants, warfarin, rivaroxiban, apixaban etc?
Do you have any allergies?
Please add here
Tell us about your medical aesthetic treatments. Have you previously had any other aesthetic treatments? Tick all that apply to you.
Botulinum Toxin
Dermal Fillers
Thread Lift
Facial Cosmetic Surgery, face lift, blepharoplasty, rhinoplasty
Facial Surgery, trauma, medical, facial implants
Skin Surgery, removal of skin cancer, moles or other lesions
Signature
*
I agree to act as a model, I understand that any treatment carried out will be undertaken by a registered healthcare professional and my photos may be used for educational/ promotional purposes.
Date
*
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Month
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Day
Year
Date
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