BBL - Intake and Consent v1 - DRAFT

Your details


Check your details
If any of the boxes below are already filled in, we have completed them from the details we hold for you. Please check they are still correct and type over anything that has changed. If they are blank, please fill them in.

Medical history

Please answer these questions as fully and accurately as you can. This information is used to keep you safe.

Please answer these questions again for today
These questions are deliberately left blank, even if you have completed this form before. Your health, medicines and circumstances can change between appointments, and we need your answers as they are today rather than as they were last time. If nothing has changed since your last visit, please still answer each question rather than leaving it blank.

No problem. There is nothing else to answer on this page. Click Next, read and tick the declarations, and sign.

When you're in clinic we'll talk through what you'd like and go through any extra questions for that treatment together before anything happens.