WELCOME TO KT BEAUTY MEDICAL CENTRE

Please select the form you need to complete before your appointment.

Your information will help our team prepare your visit with care and accuracy.

MEDICAL HISTORY FORM

1. Personal Information

Please provide your personal details:

2. Contact Information

3. Emergency Contact

4. Medical Questions

Please answer the following questions about your medical history

Do you have a latex allergy?
Do you bleed easily or bruise easily?
Do you smoke?
Are you pregnant or could you be pregnant?

5. Medical Conditions

Do you have or have you ever had any of the following?

Head Disease
Diabetes
Bronchitis
Cancer
Arthritis
Shortness of Breath
HIV/AIDS
Stroke
Asthma
Liver Disease
Kidney Disease
Epilepsy
Hepatitis
High Blood Pressure

6. Signature

⚠️ Important Notice
By signing below, I certify that the information provided is accurate and complete to the best of my knowledge. I understand that this information will be used for medical purposes.

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