medical questionnaire

Before your appointment

Before I see you, I need to know your history and what you are looking for. That is how an appointment starts right, and it is only confirmed after this.

Time: About 8 minutes
Steps: 6 short steps
Have at hand: Names of your medication

Confidential, used only for your assessment. Your answers stay on this device until you send them.

Personal details Full name *

Sex

Female Male Other

Date of birth * Nationality

Language for communication *

Português English Español

Phone number * E-mail * Address

Previous treatments

Have you had any dermal filler treatment?

Yes No

Have you ever had any cosmetic treatments?

Yes No

Have you had botulinum toxin?

Yes No

Do you wake up with a swollen face?

Yes No

Expectations Are you satisfied with your aesthetics? If you could change something, what would it be? What concerns do you have about your skin? * What treatments would you like to do? What is your expectation after treatment? Do you have an event or trip coming up? When?

How did you find Claudia Beauty Studio?

Recommendation Instagram Google Other

Consent

I authorise the use of the information above for the assessment and planning of my treatment at Claudia Beauty Studio. The data is treated confidentially, used only for clinical purposes and never shared with third parties. I declare that my answers are true and complete, and that I will report any change in my health before the appointment.

I have read and agree with the consent above. I understand that some treatments require a recovery process, which varies from person to person until the final result. I am aware that if I do not start any treatment, a €70 fee will be charged in advance for the consultation. Signature *

Some required fields are still missing, marked with *. Please check the form, the consent and the signature.