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Patch Test Consent/Waiver Form

Client Details


Medical History


Consent

While allergies to treatments are unusual, it is always possible to have a reaction in regards to any new treatment we undertake. Please read the following statements carefully.



Tap or click on the signature above to sign


Appointment Guidance

If you have tested positive for COVID-19, or have any symptoms of COVID-19 (see below) please do not attend your appointment. Please contact us as soon as you know you will be unable to attend so we can reschedule.

COVID-19 Symptoms:

  • a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
  • a loss or change to your sense of smell or taste
  • shortness of breath
  • feeling tired or exhausted
  • an aching body
  • a headache
  • a sore throat
  • a blocked or runny nose
  • loss of appetite
  • diarrhoea
  • feeling sick or being sick

SUBMIT

(disabled)


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