Medical HistoryPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Date of birth *Gender *FemaleMaleAre you taking any kind of medication topical or oral? *YesNoMedical historyAllergiesAre you pregnant? *YesNoDo you have any surgery? *YesNoMore detailsDo you have metal implants in any part of your body? *YesNoMore detailsDo you have a pacemaker? *YesNoHave you received botulinum toxin? *YesNoDate of last oneHave you received dermal fillers? *YesNoDateWhat kind?Send Covid-19 Health DeclarationPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail *My body temperature is lower than 98.6°F / 37.5°CI am not experiencing the symptoms: fever, cough, sore throat, shortness of breath.I haven´t been in close contact with a covid-19 patient in the last 14 days.Initials *Date *I declare that the info I´ve provided is accurate & completeSend Because You Deserve It, Make Your Appointment Now Make your appointment
