Parent/Guardian permission form for under 18's

Please fill this form in behalf of your minor you are a parent or guardian and where the treatment will take place. At the end you will add your personal details.

I agree to inform immediately, if mine or their body temperature is getting higher than 37 °C, develop a cough or lose my sense of taste and smell in the last 2 hrs prior the treatment

Multi-line address

Country/Region

Address

City

Zip / Postal code

Provide FREE immediate to the property parking instructions

Scar or Keloids (Dr's notes permission required)

Yes

Recent scars or surgeries (under 6 months)

Yes

Doctor's notes, if medical condition or need to adapt the treatment or upload proof of parking

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I agree with terms and conditions and I confirm information in this form is true

Signature

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