Consent Form

Consent for Aesthetic Treatments by Dr Svetlana Lakunina.

1.Name
2.What is your date of birth?
By submitting this form, I confirm that my health history is accurate and complete, I understand the side effects and possible complications related to my treatment, and I agree with the policy.
Please Note: due to subjective nature of the treatment, it is not possible to guarantee results; longevity of the treatment results may vary between individuals; patients can react differently to the same treatment; list of possible complications is not exhaustive.
3.Your medical history / pregnancy status / allergies / previous aesthetic treatments/ current medications.
4.I consent to this activity/procedure.
5.Enter date
Date
About Anti-Wrinkles Injections.
About Anti-Wrinkles injections.
About Dermal Fillers.
About Dermal Fillers.