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Advanced Skincare & Rejuvenation Treatments

Pre Consultation Form

Date of birth? - (Must be over the age of 18)
Day
Month
Year
Sex
Are you happy for LADA to store your data so we can contact you:

Compatibility Questionnaire.

If you answer YES for any one of the 9 questions below unfortunately we will not be able to offer you any Microblading treatments at this time.

If you have any questions in regards to this please use the Contact Us page to get in touch.

1. Are you currently pregnant/breast feeding?
Yes
No
2. Have you ever developed keloids or hypertrophic scars?
Yes
No
3. Have you had cancer or chemo/radio therapy in the last 3 years?
Yes
No
4. Do you have a medical diagnosis for any of the following: Epilepsy, Trichotillomania, Anxiety, Stress, Depression?
Yes
No
5. Do you have any active skin conditions on or around your eyebrows?
Yes
No
6. Do you suffer from any autoimmune disorders or other illnesses that affect the immune system?
Yes
No

For example: psoriasis, active eczema, lupus, vitiligo.

7. Do you have any blood disorders?
Yes
No

For example: Blood clots, Blood cancers, Hemophilia, Anaemia.

9. Are you currently or have you in the last 6 months finished a course of Accutane or Roaccutane?
Yes
No
8. Do you have any infectious diseases ( HIV, AIDS, Hepatitis)
Yes
No
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