Contact Us Get In Touch Email Address info@aureliarejuvenate.com Phone Number 07824445315 Office Address Stockport, Cheshire, Sk2 6Ah Make Appointment Full Name(Required)Date of Birth MM slash DD slash YYYY Contact NumberEmail Address(Required) Address(Required)Treatment DetailsTreatment TypeTreatment Date(Required) MM slash DD slash YYYY Practitioner Name(Required)Medical HistoryAre you currently taking any prescribed medications? Yes No Please List Add RemoveDo you have any known allergies (including skincare or medication)? Yes No Please SpecifyAre you pregnant, breastfeeding, or planning to become pregnant? Yes No Have you had any recent cosmetic or medical procedures? Yes No Please DescribeDo you have any ongoing medical conditions (e.g. diabetes, heart conditions, skin disorders)? Yes No Consent to Treatment– The treatment I am receiving has been fully explained to me, including possible benefits, risks, and side effects. – Results may vary depending on individual factors such as skin type, lifestyle, and aftercare. – I have disclosed all relevant medical information to the best of my knowledge. – I consent to receiving the selected treatment from a qualified practitioner at Aurelia Rejuvenate. – I will follow all pre- and post-treatment care instructions provided by my practitioner.(Required) I Understand That– The treatment I am receiving has been fully explained to me, including possible benefits, risks, and side effects. – Results may vary depending on individual factors such as skin type, lifestyle, and aftercare. – I have disclosed all relevant medical information to the best of my knowledge. – I consent to receiving the selected treatment from a qualified practitioner at Aurelia Rejuvenate. – I will follow all pre- and post-treatment care instructions provided by my practitioner. (Required) I understand and agree to proceed with the treatment.Consent for Use of Photos (Optional)I consent to Aurelia Rejuvenate taking before and after photos of my treatment area for the purpose of:(Required) My personal records Marketing (website, social media, promotional materials) I do not consent to photos being used publicly SignatureDate MM slash DD slash YYYY Data Protection & Privacy Aurelia Rejuvenate complies with GDPR regulations. Your information will be kept confidential and used only for treatment, booking, and communication purposes.Client Declaration I confirm that the information I have provided is accurate, and I understand the nature of the treatment I am receiving.Client Signature:Date MM slash DD slash YYYY Practitioner SignatureDate MM slash DD slash YYYY CAPTCHA Make Appointment Full Name(Required)Date of Birth MM slash DD slash YYYY Contact NumberEmail Address(Required) Address(Required)Treatment DetailsTreatment TypeTreatment Date(Required) MM slash DD slash YYYY Practitioner Name(Required)Medical HistoryAre you currently taking any prescribed medications? Yes No Please List Add RemoveDo you have any known allergies (including skincare or medication)? Yes No Please SpecifyAre you pregnant, breastfeeding, or planning to become pregnant? Yes No Have you had any recent cosmetic or medical procedures? Yes No Please DescribeDo you have any ongoing medical conditions (e.g. diabetes, heart conditions, skin disorders)? Yes No Consent to Treatment- The treatment I am receiving has been fully explained to me, including possible benefits, risks, and side effects. - Results may vary depending on individual factors such as skin type, lifestyle, and aftercare. - I have disclosed all relevant medical information to the best of my knowledge. - I consent to receiving the selected treatment from a qualified practitioner at Aurelia Rejuvenate. - I will follow all pre- and post-treatment care instructions provided by my practitioner.(Required) I Understand That- The treatment I am receiving has been fully explained to me, including possible benefits, risks, and side effects. - Results may vary depending on individual factors such as skin type, lifestyle, and aftercare. - I have disclosed all relevant medical information to the best of my knowledge. - I consent to receiving the selected treatment from a qualified practitioner at Aurelia Rejuvenate. - I will follow all pre- and post-treatment care instructions provided by my practitioner. (Required) I understand and agree to proceed with the treatment.Consent for Use of Photos (Optional)I consent to Aurelia Rejuvenate taking before and after photos of my treatment area for the purpose of:(Required) My personal records Marketing (website, social media, promotional materials) I do not consent to photos being used publicly SignatureDate MM slash DD slash YYYY Data Protection & Privacy Aurelia Rejuvenate complies with GDPR regulations. Your information will be kept confidential and used only for treatment, booking, and communication purposes.Client Declaration I confirm that the information I have provided is accurate, and I understand the nature of the treatment I am receiving.Client Signature:Date MM slash DD slash YYYY Practitioner SignatureDate MM slash DD slash YYYY CAPTCHA Book Your Appointment For Relaxation We offer Special Discount for NHS Staff.