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?*