Online Questionnaire Booking form:

* Indicates required field

First Name*

Surname*

Date of Birth *

Phone Contact*

Email Contact*

 

How long have you been suffering from Hyperhidrosis (excessive sweating):*

 

Have you tried clinical strength aluminium-based antiperspirants for at least 1 months?*

YesNoI can not use them

Do you have any other medical conditions (please list)?*

What medications do you take (please list with doses)?*

Do you have any medication allergies (please list name of medication/s)?*

Are you currently on any medications?*