Book Appointment

  • 1 Your Information
  • 2 Disclosure Questions


    Brazilian Beauty Bar Disclosure Questions

    1.

    Do you have any blood clots?

    YesNo
    2.

    Have you had any flu/cold/strap throat/fever type symptoms with in the last 7 days?

    YesNo
    3.

    Do you currently have an active bacterial or viral infection?

    YesNo
    4.

    Do you currently have any acute inflammation cause by an
    injury, bacteria or a virus?

    YesNo
    5.

    Do you have high/low blood pressure?

    YesNo
    6.

    Are you pregnant?

    YesNo
    7.

    Have you had Botox or Fillers during the last 2 weeks?

    YesNo
    8.

    Have you had any surgeries in the last 12 months?

    YesNo

    9.

    Have you recently been diagnosed with Cancer?

    YesNo
    10.

    Are you undergoing Chemotherapy?

    YesNo
    11.

    Do you have any heavily inflamed varicose veins?

    YesNo
    12.

    Do you have any Auto-Immune Diseases?

    YesNo
    13.

    Have you had a Cortisone injection in the last 72 hrs?

    YesNo