MEDICAL INFO Por favor, activa JavaScript en tu navegador para completar este formulario.Full name *NombreApellidosEmail *Phone numberDate of birthGenderFemaleMaleAre you taking any kind of medication topical or oral?YesNoMedical storyAllergiesAre you pregnant?YesNoDo you have any surgery?YesNoMore detailsDo you have metal implants in any part of your body?YesNoMore detailsDo you have a pacemaker?YesNoHave you received botulinum toxin?YesNoDate of last oneHave you received dermal fillers?YesNoNombre and kind *NombreApellidosSend Covid-19 Health Declaration Por favor, activa JavaScript en tu navegador para completar este formulario.Name *NombreApellidosEmail * *My body temperature is lower than 98.6°F / 37.5°CI am not experiencing the symptoms: fever, cough, sore throat, shortness of breath.I haven´t been in close contact with a covid-19 patient in the last 14 days.Initials *Date *I declare that the info I´ve provided is accurate & complete.Send
