Treatment Settings- ND Yag Form

Tattoo Removal, Pigmentation Removal, Birthmark Removal, Nevus of Ota, Carbon Facial

Name*
First Last
DOB*
Date of Birth

Day
Month
Year
Phone*
Email
Address*
Street Address City County / State / Region ZIP / Postal Code Country
Treatment Type*
Select a treatment you are having today
Which Patch Test*
Select a patch test type
Treatment Area(s)*
List all treatment areas
Price*
Price payable for this session
Quotation & Notes*
Quotation and notes regarding the treatments. E.g Quoted customer £200 per session for hand and chest
Consent*
I have been advised on how to care for my skin after the AW3® treatments. I will follow the procedure as advised to me. There has been no changes to my health since my last treatment and I am not taking any new medication.
- Accept Treatment