Consultation pre patch test

Name*
First Last
Date*
Date Format: DD slash MM slash YYYY
Address*
Street Address City ZIP / Postal Code
Email*
Enter Email Confirm Email
Phone*
Date of Birth*
Occupation
What areas are you coming for laser treatment on?*
Where did you find out about Metro Laser Clinic?*
Have you already purchased sessions online?*
How many sessions did you purchase if yes?
Please tell us more if you've had Laser or IPL treatments before enter none if you haven't:*

Your Doctor's Name
Prefix Last
Doctor's Address
Street Address Address Line 2 City
Please tell us of any medical conditions you have - if none type 'none'*
Please tell us of any medications you are currently taking if none type 'none':*
Are you pregnant, have a light allergy, history of cancer, auto immune condition, taken anti acne medication (Accutane) in the last six months or have photosensitivity
Please confirm you have watched our info video*
- Yes I watched it
- No I haven't
- Can't access it

Almost there... Please remember to write down the door entry code we sent you to gain access to the waiting area. You can also purchase plans from us cheaper than anywhere else and we appreciate if you refer friends direct to us. You'll find a printed consent form that you need to initial and sign on arrival. You may reschedule appointments on our online booking system following the links at the bottom of the appointment email. The easiest way to contact us is on the clinic mobile by text 07739 479682 if you're delayed etc.

Metro Laser Clinic - Low Cost Laser