Online Questionnaire

Please read the following information carefully before completing this questionnaire.

Age Restrictions: We are unable to offer pharmaceutical treatment to individuals under the age of 18. If the person completing this form is under 18, a parent or legal guardian must be present during all consultations and communications.

Medical Conditions and Medications: If you have any medical conditions or are currently taking medication, you should consult your doctor before undergoing any treatment. We will ask you specific health-related questions to ensure the service is safe and appropriate. Certain treatments may not be suitable if you have particular health conditions or are on specific medications.

Health Information and Consent: Where we collect information about your health or medical circumstances, we do so with your explicit consent and in line with our legal obligations for health & safety and insurance purposes. This information is essential for delivering safe, tailored advice and treatment.

Data Protection and Privacy: All personal and health-related data is handled in accordance with the Data Protection Act. Your information is stored securely and used only for the purposes described in this form and in our Privacy Notice. Data may be shared with our partner pharmacy solely for treatment-related purposes.
 
By completing this form, you confirm that the information provided is accurate and that you understand and accept the terms outlined above.

Step 1 of 5

1. CLIENT INFORMATION

Name
Address
(day/month/year)
Gender