Digital Consent

Complete your consent form online ahead of your appointment. All information is held in the strictest confidence.

Treatment & Client Details

Treatment *

Full name *

Date of birth *

Email *

Phone *

Address *

Emergency contact (name & number) *

Medical History

Please list any medical conditions

Current medications

Known allergies

Are you pregnant?

Yes No

Are you breastfeeding?

Yes No

History of cold sores?

Yes No

Bleeding disorders?

Yes No

Have you had aesthetic treatments before?

Yes No

Contraindication Checks

Active skin infection at treatment area?

Yes No

Recent sunburn or significant tan?

Yes No

Autoimmune conditions?

Yes No

Recent dental treatment (within 2 weeks)?

Yes No

Treatment-Specific ConsentI understand the nature, risks and possible side effects of my treatment as discussed during consultation.I understand results vary, and that no specific outcome can be guaranteed.I confirm the information provided is true and complete to the best of my knowledge.I consent to before/after photographs being taken for my medical record.I consent to my data being processed in line with the No.1 Clinic Privacy Policy.

Signature

Type your full name as signature *

Date *

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No.1Clinic

Luxury aesthetic & beauty treatments delivered with medical precision and genuine care.

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Floors 1 & 2, 1 Cornhill,
Bury St Edmunds, Suffolk IP33 1BE
hello@no1clinic.uk

Mon – Fri: 9:00 – 19:00

Saturday: 9:00 – 17:00

Sunday: By appointment