Skip to content
Home
Treatments
Dermal Fillers –
Cheek Fillers
Lip Fillers
Jaw Fillers
Tear-Trough Treatment
Chin Augmentation
Dermal Filler Nose Treatment/ Liquid Rhinoplasty
Dermal Filler Chin Treatment
Botox/Azzalures
Botox / Azzalures / Anti – Wrinkle Treatments For Men
Aqualyx & Fat Dissolving
Profhilo & Skin Boosters
Jalupro
4D Hifu – Vmax
Skinnyjab
PRP
Aqua GOLD Facial
Skinny Pen – Weight Loss
Vitamin B12 Injections
Vitamin C Injections
Book Appointment
Price List
Consent Form
Contact
Contact
Locations
Blog
Social Media
Brentwood, Essex
Brentwood Treatment Room
Online Courses
Facial Anatomy and Physiology For Aestheticians Level 3
Microneedling Facial
All Courses
Courses
Course Prices
Training in Botox (anti-wrinkle)
Training in – Aqualyx Fat Dissolving
Training in – Profhilo
Training in – Vitamins
Training in – Dermal Fillers
Training
Menu
Home
Treatments
Dermal Fillers –
Cheek Fillers
Lip Fillers
Jaw Fillers
Tear-Trough Treatment
Chin Augmentation
Dermal Filler Nose Treatment/ Liquid Rhinoplasty
Dermal Filler Chin Treatment
Botox/Azzalures
Botox / Azzalures / Anti – Wrinkle Treatments For Men
Aqualyx & Fat Dissolving
Profhilo & Skin Boosters
Jalupro
4D Hifu – Vmax
Skinnyjab
PRP
Aqua GOLD Facial
Skinny Pen – Weight Loss
Vitamin B12 Injections
Vitamin C Injections
Book Appointment
Price List
Consent Form
Contact
Contact
Locations
Blog
Social Media
Brentwood, Essex
Brentwood Treatment Room
Online Courses
Facial Anatomy and Physiology For Aestheticians Level 3
Microneedling Facial
All Courses
Courses
Course Prices
Training in Botox (anti-wrinkle)
Training in – Aqualyx Fat Dissolving
Training in – Profhilo
Training in – Vitamins
Training in – Dermal Fillers
Training
Search
Search
Close this search box.
Consent Form
Please enable JavaScript in your browser to complete this form.
Name
*
Date of Birth
Mobile Number
Home Address & Post Code
Home Address & Post Code
Email
*
Please select the following if you are allergic to...
Plasters
Iodine
Antibiotics
Stitches
Local Anaesthesia
Beef/Pork
Tick if you have ever suffered from any of the following...
Heart Disease/Angina
Auto-immune Disease
High/Low Blood Pressure
Stomach Ulcers/Colitis
HIV/Hepatitis
Venereal Disease
Phlebitis
Thyroid Problems
Arthritis
Convulsions
Depression
Diabetes
Acne/Skin Problems
Glaucoma/Cataract
Bells/Facial Palsy
Hypoglycema
Neuromuscular Disorders
Bleeding Disorders
Take Blood Thinners
Heart Problems
Carry an EPI Pen
If you ticked any of the above boxes please contact us as soon as possible to discuss your treatment
Please let us know if there is anything that may be relevant to your treatment that we should know prior to treatment....
Click below to agree to the following....
I have read and understood all the information provided
I agree to proceed with the treatment at my own choice/risk
I have provided truthful medical history
I am over 18, and carry this treatment out of my own choice
GDPR Agreement
*
I consent to having this website store my submitted information so they can respond to my inquiry.
Please click to acknowledge...
I will avoid alcohol 24 hours before and after treatment
I understand there is a chance of bruising/swelling
I am not pregnant//breastfeeding
Name
*
First
Last
Emergency Persons Name & Contact Number
Message
Submit
CALL ME
+
We will call
you
back in 00:
48
seconds!
Call me!
Introduce yourself, and we'll call you by name
call us
We use cookies to give you the best experience on our website. If you continue to use this site we will assume that you are happy with it.
Ok