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Covid-19 vaccination and Facial Aesthetics Treatment Questionnaire

Covid-19 (Coronavirus)

To help keep all patients and staff safe, please can you respond to the following questions?

Have you had any of the following in the past 14 days? PLEASE TICK ALL THAT APPLY. *

Have you had your Covid-19 Vaccination? *

If you have your Covid-19 vaccination booked in future please give us the date (1st or 2nd dose)

Please add any additional information you may want to share with us prior to your appointment

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