Medium

Available on

Apple Android Windows

Double Peel Facial Therapy Consultation Form Mobile App

This mobile app is used as a consultation and consent form for dermatologic treatment. The consultation section of the app collects personal information and medical history regarding the patient. The consent portion outlines the terms and conditions for the therapy and has the capability to capture signatures for authorization.

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

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Take a peek inside the Double Peel Facial Therapy Consultation Form Mobile App

Included Features

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Included Fields

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

  • Ico textbox

    Name:

  • Ico multiline

    Address:

  • Ico textbox

    Home Phone:

  • Ico textbox

    Mobile:

  • Ico textbox

    Work No:

  • Ico textbox

    What area do you want treated?

  • Ico date

    Birthday (So we can send you a gift for your birthday)

  • Ico textbox

    Profession (Receive special offers tailored to your free time)

  • Ico dropdown

    How did you hear about us?

  • Ico textbox

    If you were referred by someone who was it?

  • Ico dropdown

    Any allergies?

  • Ico dropdown

    Are you taking any medications?

  • Ico multiline

    Please List:

  • Ico statictext

    Check all the issues that concern you:

  • Ico checkbox

    Ageing

  • Ico checkbox

    Wrinkles

  • Ico checkbox

    Acne

  • Ico checkbox

    Oily Skin

  • Ico checkbox

    Dry Skin

  • Ico checkbox

    Blackheads

  • Ico checkbox

    Cellulite

  • Ico checkbox

    Slimming

  • Ico checkbox

    Sun Damage

  • Ico checkbox

    Brown Sun Spots

  • Ico checkbox

    Broken Veins

  • Ico checkbox

    Skin Redness

  • Ico checkbox

    Rosacea

  • Ico checkbox

    Nails

  • ...and More!

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