Consultation Form - FOLDE + SONDER

Consultation Form

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Name *

First

Last

Title

Date of Birth *

Address

and use? Retinin

Email *

Postcode *

Occupation

Mobile *

Home Phone

Emergency Contact *

Emergency Contact Number *

How did you hear about us: *

Health conditions:

Health conditions - other

Skin concerns / conditions:

Skin concerns / conditions - Further details

Have you ever used Roaccutane, Accutane or Retinin A? *

Have you ever used Roaccutane, Accutane or Retinin A? - Please specify:

What skincare brand(s) do you currently use?

How would you like to feel after you treatment today?

Full terms and conditions can be found on our website: https://foldeandsonder.com/terms-conditions *

I confirm to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.

I can confirm that I have read and understood the terms and conditions. *

If you are a child aged 16 or 17, you will need parental consent. Please ask your parent to check and sign this form, below.

Guardian

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