Liquid Lipo Products

Name(Required)
MM slash DD slash YYYY
Address(Required)
Do you have any allergies to anything including medication latex or rubber?(Required)
Did you need hospitalisation?
Do you carry an EpiPen?
Have you ever had any reactions to skin products(Required)
Did you need hospitalisation? If you have answered yes to any of the above please come in for a patch test 72 hours prior to the treatment session
Are you currently well?(Required)
Do you have a history of the following (tick all that apply)(Required)
Treatment Area (tick all that apply)(Required)
If Lipoma is being treated has this been diagnosed by a medic?
Consent I have read the Liquid Lipo and understand and agree to the Consent Policy(Required)