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Advanced Skincare & Rejuvenation Treatments

Pre Consultation Form

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

Compatibility Questionnaire.

Please answer all of the questions below honestly to best of your knowledge. Don't worry if you answer yes to any of these questions, this doesn't mean you are ineligible for the treatment, we may just need some more information.

1. Have you had cancer or chemo/radio therapy in the last 3 years?
Yes
No
2. Do you have any infectious diseases ( HIV, AIDS, Hepatitis)
Yes
No
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