Luxury beauty treatments in the heart of London
Luxury beauty treatments in the heart of London
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CONTACT
TREATMENTS
Packages
Lashes
Facials
Permanent Makeup
Brows
BRIDAL
ABOUT US
CONTACT
BOOK
Thanks for booking your treatment with us!
Please fill in the form below
Your Details
Date of birth
Your Doctor's Details
GDPR Consent
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Consultation questions
Currently, are you:
Undergoing medical treatment
Yes
No
Taking any over the counter/prescription medication or herbal/natural remedies on a regular basis.
Yes
No
Pregnant?
Yes
No
Breastfeeding?
Yes
No
A smoker?
Yes
No
Do you:
Have any current chronic or serious medical illnesses such as:
Diabetes
Heart disease
Angina
Epilepsy
Hepatitis
Blood disorders
Cancer
Have any auto-immune diseases such as:
Psoriasis
Lupus
Rheumatoid arthritis
Any other condition which may weaken your immune system
Have any known allergies including topical anaesthetics, nuts and/or metals?
Yes
No
Please tick any of the following conditions that apply to you:
Vitiligo that has moved in the last year
Scleroderma (diagnosed)
Trichotillomania
Alopecia
Recent hair loss
Chapped Lips
Impetigo (present)
Bleed easily with minor injury
Bruise easily with minor injury
Scar easily with minor injury
Keloid scar with minor injury
Skin heals dark with minor injury
Scars heal in raised manner with minor injury
Inflammatory Skin Condition in treatment area (Inflamed Acne, Psoriasis, Dermatitis or Eczema)
Cosmetic allergies
Undiagnosed Lumps or Pain in site
Cuts or Abrasions in site
Scar on treatment site
Moles/birthmarks in treatment site
Not Applicable
Have you received any of the following treatments? please tick all that apply.
Spray Tan (present)
Sun beds and tanning regularly
Sunburn (present)
Dermal Fillers (in last 2 weeks)
Botox (in last 2 weeks)
Eyelash and Eyebrow Tinting in last month
Chemical Peel (in last 6 months)
Dermabrasion close to site in last 6 months
AHA Skin Preparation (in last 2 weeks)
Retin A/Retinol
Isotretinoin (Roaccutane/Accutane) within 6 months
Not Applicable
What are your main skin concerns? Tick all that apply.
Acne
Large pores
Acne scarring
Dehydrated skin
Cysts/nodules
Age spots
Oily skin
Melasma
Redness
Dull complexion
Blackheads
Excessive facial hair
Rosacea
Body acne
Rough/uneven skin texture
Milia
Sun damage
Frequent breakouts
Hyperpigmentation
Other
How would you describe your skin?
Oily
Dry
Sensitive
Combination
How would you describe your stress levels?
Minimal
Moderate
High
Severe
What skincare products are you currently using?
Cleanser
Toner
Moisturiser
Facial oil
Serum
SPF
Eye cream
Exfoliating scrub
Self tan
Enzymes
Makeup
Acids/peels
Consent Agreement
I give consent for the following treatment, Microneedling / The Million Dollar Facial to be performed by AA BEAUTY. I understand the treatment uses a dermapen device to create micro needle punctures that cause mild trauma to the skin’s surface to stimulate the natural production of new collagen and elastin. I confirm that I understand the risks and conditions associated with Microneedling and that it is an elective procedure. I confirm that all risks have been fully explained to me and I have had the opportunity to ask any questions and these have been answered to my satisfaction.
I confirm that the medical history and medication details that I have supplied are complete and correct and that there is no other medical information I need to disclose. I understand that withholding any medical information may be detrimental to my health and safety during the treatment in which I agree to undertake. If there is any change in my medical history, it is my responsibility to advise the practitioner before further treatments are carried out..
I understand that there are certain contraindications that would preclude me from receiving treatment including an active bacterial, viral, fungal or herpetic infection, rasied moles or warts, active acne, rosacea, facial cancers, history of radiation therapy within the application area, a history of abnormal scarring, keloids, atrophic skin, autoimmune disorders, haemophiliac, diabetes, taking anticoagulants, pregnant or breastfeeding and being under the age of 18. I accept and understand that there are no written, implied or verbal guarantees as to the anticipated results of this treatment and that the effects of treatment will vary with some patients than with others. The goal is improvement, not perfection.
I understand I may require a series of treatments, normally with 4-6 weeks between procedures, to achieve the maximum cosmetic result. I have been given post treatment advice and I understand and agree to follow all the instructions carefully to minimise the risk of side effects. I confirm that I have been allowed sufficient time to make a carefully considered decision about my treatment options..
I confirm I have read and understood the above
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Client Declaration Date
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