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COVID-19 Update

eJoli

eJoli Aesthetic Treatment Electronic Consent Form

(COVID-19 concession)

Since you have last visited or contacted eJoli ...

Is your medical history is up to date?

Yes

No

Has your medication history changed?

Yes

No

Do you have any new allergies?

Yes

No

Have you had any other aesthetic treatment?

Yes

No

Please call us for if there are any changes in your information

I confirm all my answers are accurate and I have read eJoli COVID-19 update document.COVID-19 Update

I am aware of the treatment indication and any possible side effect and complication.click here for more information

Your Signature

date

time

Thanks for submitting!

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