Medical Questionnaire


Please indicate if you have any of the following:

Have you had Botox or any other fillers in the past 8 weeks?       

Do you have any heart conditions?                                            

Do you have a pacemaker?                                                      

Do you have any mechanical implants?                                       

Have you an Implanon insertion in your arm?                              

Are you pregnant, post-partum or breastfeeding?                        

Do you have kidney or liver disease?                                          

Do you have HIV?                                                                      

Have you just completed a course of antibiotics?                           

Are you currently on antibiotics                                                   

Do you have any skin conditions such as psoriasis                          

Do you have asthma?                                                                 

Do you have diabetes?