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Consent

Ear wax removal / check up

Consent forms for Ear wax removal / Ear check ups

Health declaration

Please fill out the following form.

Date of birth
Day
Month
Year
Medical History
Hearing aid user
History of ear infections
History of ear surgery
Tinnitus
Vertigo/balance problems
Recurrent wax build up
Symptoms of blockage/ pain
Hearing loss
Other
Which ear(s) are affected
Right
Left
Both
Have you used ear drops?
Yes
No
Birthday
Day
Month
Year

Select what's relevant to you:

The nature and purpose of BioRePeel.

  • Possible side effects include: temporary redness, tingling, flaking, peeling, breakouts, tightness, hyperpigmentation (especially if aftercare not followed).

  • Results vary per individual; no guarantees can be made.

  • The importance of following pre- and post-care instructions (SPF, no picking, avoid actives for 5–7 days).

  • Multiple treatments may be required for best results.

DeclarationI confirm that I have provided full and accurate information regarding my medical history, medications, allergies, and skincare use. I have read and understood the information contained in this consent form, including the nature of the treatment, possible risks, and the aftercare advice. I understand that results may vary and that no guarantee of outcome can be made.

I consent to before-and-after photographs being taken as part of my treatment record. These images will be stored securely with my client file in line with GDPR requirements and will not be shared without my written permission.

By signing below, I confirm that I understand the above and give my consent to proceed with treatment.


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BioRePeel

Before your treatment, we’ll ask you to complete a consent form to ensure it’s safe and suitable for your skin. This covers your medical history, current skincare routine, and any allergies or sensitivities. It’s also your opportunity to ask questions and make sure you understand the treatment, possible side effects, and aftercare. By signing, you confirm that you’ve shared all relevant information and are happy to proceed. 

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