Follow Up Form | MADA Clinic and Spa

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Nr 1 KLINIKA SKÓRY

SMITHFIELD, DUBLIN!

Formularz uzupełniający

Prosimy o poświęcenie chwili na wypełnienie formularza.

First name

Last name

Birthday

Email

Phone

When was your last sun / sun beds exposure or fake tan application?

Have you had any medical changes since your last treatment? New diagnoses or medications?

Are you pregnant or breast feeding?

Have any conditions changed since completing your last consultation form?

Date of signing

Your Signature

Thanks for submitting!

Dołącz, aby otrzymywać ekskluzywne oferty & rabaty

Enter your email here

Thanks for submitting!

Jesteśmy otwarci

Wtorek-czwartek: 11:00-19:00

Piątek: 12:00 - 20:00
Sobota: 10:00-16:00

Adres: Jednostka 2, Block E, Thundercut Alley, Queen St, Smithfield, Dublin 7, Irlandia

Obsługa klienta

Telefon: 01 575 9865

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