linca aesthetics

consultation form

Confidential medical questionaire.
Please answer Yes or No. If yes, please give details or explain.
I hereby consent and authorise Linca Aesthetics to perform the procedure(s) booked.

I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved.

Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the clinic immediately.

I have also, 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 consent to be photographed before, during and after treatment. I understand that these photographs would remain the property of the professional practice and will not be used for marketing purposes without my explicit permission.

I understand that Linca Aesthetics will not issue a refund for any reason, once the treatment is completed, unless required by statutory law.

I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement.

I do not hold, Linca Aesthetics responsible for any of my conditions that were present, but not disclosed at the time of the procedure, which may be affected by the treatment performed today.

Linca Aesthetics are committed to ensuring protection of all personal information that we hold, and to provide and to protect all such data. We recognise our obligations to meet the requirements of GDPR.

age verification

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