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Cosmetic Consultation Form (United Kingdom) Mobile App

Use this Cosmetic Consultation Form mobile app as away to obtain patient clinical records prior to a cosmetic surgery appointment. A patient coordinator or dermatologist can use this form on a smartphone or tablet to easily gather information about a patient such as personal and health information including previous medical conditions, their current medical status, insurance company and more.

The app can also be used to give an overview of cosmetic procedures offered by the surgeon such as a breast augmentation, facelift surgery, eyelid surgery, tummy tuck, etc.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Cosmetic Consultation Form (United Kingdom) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    This questionnaire is part of your confidential clinical records.

  • Ico statictext

    If you are unsure of an answer, or have any other questions about how we can help you, please don...

  • Ico dropdown

    Title:

  • Ico textbox

    Surname:

  • Ico textbox

    Forename:

  • Ico date

    Date:

  • Ico dropdown

    Sex:

  • Ico multiline

    Address:

  • Ico textbox

    Postcode:

  • Ico textbox

    Telephone (Home):

  • Ico textbox

    Telephone (Work):

  • Ico textbox

    Mobile:

  • Ico textbox

    Email:

  • Ico textbox

    Occupation (last job if retired/unemployed):

  • Ico dropdown

    Pregnant:

  • Ico dropdown

    Breastfeeding:

  • Ico dropdown

    Contraceptive Pill:

  • Ico dropdown

    Taking HRT:

  • Ico dropdown

    Smoker:

  • Ico textbox

    GP Name:

  • Ico multiline

    GP Address:

  • Ico dropdown

    Would you like us to inform your GP about your treatment?

  • Ico checkbox

    Yes

  • Ico checkbox

    No

  • Ico multiline

    Details:

  • Ico dropdown

    Condition:

  • Ico checkbox

    Yes

  • Ico checkbox

    No

  • ...and More!

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