Pre-Booking Form

Booking
Health & Medical History
Please check any of the following that apply**

Contagious Skin DisordersCancer, Chemo or RadiationDiabetesCardiac DiseasePacemaker or Internal DefibrillatorLaser or IPL within last 7 daysRoaccutane or other prescription medicinePhotosensitizing MedicationBlood thiners/AsprinMetal plates/pinsHigh/Low Blood PressurePregnancy/BreastfeedingVascular ConditionsVaricose VeinsMetabolic ConditionsHypertriglceridemiaHearing aids - will need to be turned off and removedLiver disease or high cholesterolAutoimmune disease or poor lymphatic SystemCold soresSkin irritation, rash, open lesionsNone of the above
count
If you checked yes to any of these please provide further information.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Should be Empty:

Booking