B12 SELF-INJECTION MEDICAL Declaration form

PLEASE COMPLETE TO PROCESS YOUR ORDER:


NAME *
NAME
WHICH B12 SELF-INJECTION KIT DO YOU REQUIRE? *
DELIVERY DETAILS
NAME *
NAME
ADDRESS *
ADDRESS
YOUR HEALTH & WELLBEING NEEDS
HAVE YOU HAD B12 SHOTS BEFORE? *
DO YOU CURRENTLY SELF-INJECT OR HAVE YOU PREVIOUSLY? *
MEDICAL DECLARATIONS
MEDICAL DECLARATION 1 *
By checking this box I confirm that ALL of the information I have given on this order form constitutes full disclosure of my health and medical conditions.
MEDICAL DECLARATION 2 *
By checking this box I confirm that I have read the written instructions regarding the B12 Self-Injection Kit. I confirm that I understand the self-injection technique and I feel confident in carrying out this procedure. I understand that if I have any questions, queries or concerns regarding any aspect of the self-injection procedure I must contact Dr Ayanna Knight - Cosmetic Skin Care, Health & Wellbeing Clinic prior to using this service.

If you would prefer to book an in clinic consultation with Dr Ayanna Knight for B12 Methylcobalamin Self-Injection Kit, please click the button below



WHY CHOOSE DR AYANNA KNIGHT'S CLINIC?

> Highly trained medical professional with over 10 years of clinical experience. Trained in advanced aesthetic procedures including PROFHILO Skin Rejuvenation and Fractional Laser Skin Resurfacing for Acne Scarring and Melasma.

> Innovative technology and industry leading premium products including Allergan Botox, Juvederm Dermal Fillers and OBAGI Skin Care to maximise results.

> Doctor led clinic with a commitment to patient safety. Ongoing training to keep up to date with the latest aesthetic procedures and medical developments.

> Full medical consultations with skin health and lifestyle assessment to ascertain suitability for treatment and tailor a treatment plan to suit your individual needs.

> Complete wrap-around client care from consultation to aftercare. Close post treatment follow-up to attend to any concerns, review results and ensure patient satisfaction.

> Luxury, contemporary clinic in an accessible, discrete location. Clinic amenities include free, secure, allocated parking, cocoon acoustics by Harman Kardon and complimentary WiFi internet connection.