Consultation Form

Name

Phone/Whatsapp Number

Address

On Going Skin Concerns

Do you currently have or have you previously experienced any medical conditions, skin conditions, allergies, or other conditions that may be relevant to your treatment?

If yes, please provide details

Are you currently taking any medication or undergoing any medical treatment that may affect your skin or treatment?

If yes, please provide details

Consent

I agree and consent to receive treatment at Melangé Korea and acknowledge that the potential risks associated with the treatment have been explained to me.

I confirm that the information I have provided is accurate and complete.