Treatment Information: Non-Surgical Treatments and Cosmetic Injections

Gift Vouchers

Gift Vouchers

Upper And Lower Face Lines And Wrinkles

Dermal Fillers

Red Vein, Spider Vein And Thread Vein Removal

Radio Frequency

Laser Treatment

Skin Clinic

Are You A Salon Owner?

  • Log In

    Cosmetic Treatments throughout the West Midlands

    Acocks Green | Albrighton | Aldridge | Alvecote | Aylesford | Baginton | Balsall Common | Balsall Heath | Barston | Bentley | Berkswell | Bilston | Binley | Birmingham | Birmingham Airport | Bloomfield | Bloxwich | Brierley Hill | Brierly Hill | Brockmoor | Brownhills | Bubbenhall | Castle Bromwich | Claverley | Clent | Codsall | Coleshill | Corley | Countywide | Coventry | Cradley Heath | Dorridge | Dudley | Edgbaston | Enville | Erdington | Forhill | Gornal Wood | Halesowen | Handsworth | Harborne | Henley-in-Arden | Hockley | Keresley | Kings Heath | Kingswinford | Knowle | Lapworth | Lickey | Longford | Marston Green | Meriden | Minworth | Moseley | Nechells | New Quay | Northfield | Oldbury | Pensnett | Princes End | Quarry Bank | Rowley Regis | Rushall | Ryton on Dunsmore | Sandwell | Sedgley | Selly Oak | Shelley | Small Heath | Smethwick | Solihull | Stourbridge | Sutton Coldfield | Tettenhall Wood | Tipton | Tividale | Wall Heath | Walsall | Wednesbury | West Bromwich | Whitacre Heath | Willenhall | Wishaw | Wollaston | Wolverhampton | Wombourne | Wootton Wawen | Yardley |  

     

     

     

    • Cosmetic Treatment - Medical Questionnaire

    Please fill out the form below
    Email:*
    DOB:*
    Age:*
    Clinic Being Treated At:*
    Personal Details
    First Name:*
    Middle Name:
    Surname:*
    House Number/Name:*
    Street:*
    Town/City:*
    County:*
    House Phone Number:*
    Work Phone Number:
    Mobile Phone Number:
    Current Employment Details:*
    Family History
    Any relevant medical history i.e. inheritable conditions - Heart, Strokes, Diabetes etc:*
    General Medical History
    Have you had Botox, Visable Or Dysport before?* Yes
    No
    If Yes, when?
    Was the treatment satisfactory? Yes
    No
    If Yes, please give details:
    Were there any medical complications with the treatment? Yes
    No
    If Yes, please give details:
    Have you been to see a GP, Doctor, Nurse, Dentist or Pharmacist?* Yes
    No
    If Yes, when?
    Also, if yes, please give details of Complaint, Treatment, and/or Outcome e.g Has this concern/complaint been resolved?
    Are you currently taking any medication-either on prescription or otherwise?* Yes
    No
    If Yes, give details:
    Are you taking any asprin/ warfarin/ steroids?* Yes
    No
    If Yes, give details:
    Have you had any major surgery within the last 3-6 months?* Yes
    No
    If yes please give details:
    Is there any aspect of your general health, or specific complaint you feel we might need to consider, however minor/trivial you feel it may be. Please give details:*
    Medical History Precautions
    Is there any possibility that you are pregnant?* Yes
    No
    Are you breast feeding?* Yes
    No
    Have you recently been treated with any other dermal filler/cosmetic injection on our face?* Yes
    No
    If Yes, where and what?
    Do you have any permanent implants?* Yes
    No
    If Yes, please give details:
    Have you undergone laser resurfacing or received a skin peel in the past 6 weeks?* Yes
    No
    Do you suffer from facial herpes simplex or have any active skin conditions, e.g. acne or psoriasis?* Yes
    No
    Do you have or have you ever had any form of skin cancer?* Yes
    No
    What are your expectations of the outcome of the treatment?*
    Specific questions about the treatment you want
    What area of your face are you considering having treated Frown Lines
    Crows feet
    Bunny lines
    Crunch lines
    What area of your lower face are you considering having treated Nose to mouth lines
    Smokers lines
    Edge of mouth
    Mouth to chin lines
    Lines on chin
    Lines on jaws
    What other areas are you considering having treated?
    What products are you considering Don’t know
    Botox
    Restylane
    Juvederm
    Radiesse
    Sculptra
    Vital Light
    Sub-Q
    Any other comments?
     

    E-mail info@tinkable.co.uk

    Telephone 01384 37 37 34 or 0121 233 47 37.