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Client Health Declaration

Complete the form below prior to your first appointment. 

Client Health Declaration

Please complete the form below to the best of

your ability and contact me with any further questions.

Are you suffering from a medical condition to do with high blood pressure, a heart condition or a blood disorder?
Do you suffer from any form of skin condition in and around the treatment area? For example; acne, eczema, psoriasis, rashes, blisters, skin sensitivity?
Are you taking any of the following medication?

Thank you for completing the health declaration!

The Farnham Aesthetics Co.

The Carlton Yard Clinic

Unit 1 Carlton Yard, Victoria Road, Farnham, GU9 7RD

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Text or WhatsApp for a call back: 07958 657267

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helen@theaestheticsco.uk

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©2019-2026 by The Aesthetics Co.

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