II HEALTH CONDITION
Tick if you have any of the following condition
*
Heart Condition
Diabetes
Thyroid Problems
Joint Problem
Skin Sensitivity
Acene
Renal Disorders
Pregnancy
High/LowBloodPressure
Epilepsy
Allergies
MuscularPain
Asthma
Psoriasis/Eczema
Hormonal Imbalance
Fever
Recent Surgeries
PaceMaker
Depression
Venous Insufficiency/ Varicose vain
Is there anything else regarding your health we should know prior to treatment?
*
Have you recently undergone any intensive facial treatment such as dermabrasion, laser or both
*
Are you currently practicing any meditation or taking any supplements?
Yes
No
If yes mention name
Do you have any particular area of tension/pain
Yes
No
Do you wear contact lenses?
Yes
No
Have you had this treatment before?
Yes
No
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