Consultation Form

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Multi choice

Diabetic with Microangiopathy

Autoimmune disease

Scleroderma

Hepatic

Acute Infections & Chron infection risk

Severe adiposities (adiposities per Magna BMI>30

Hypersensitivity against ingredients

Severe kidney disease

Blood coagulation disease

Neuromuscular (i.e. MS, ALS, Motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome

Skin conditions

Anaphylaxis

Do you have any active infection at the intended site of the procedure

Are you taking antibiotics

Are you pregnant or breast feeding?

Have you had any issues with cosmetic procedures in the past?

Are you under investigation or waiting diagnosis?

If yes please provide details below

Will You will contact Popsy Woo if you experience any side affects from your treatment?

What are your aims/motivations for having the procedure and the desired outcome? please provide details here.

Consent: I can confirm that the information provided is accurate. I accept the risks and complications of the procedures. I consent to the procedure being carried out at Popsy Woo Aesthetics following face to face consultation.

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Advanced clinical skin rejuvenation clinic focused on real, measurable change in your skin.

Visit Us

Studio 18, 18 High Street, Sandy, Bedfordshire, SG19 1AQ

07516 139616 / 01767 681531

Hours

Mon: 10am-5pm | Tue: Closed | Wed-Sat: 10am-5pm | Sun: Closed

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