Pre-Consultation Form

Please complete this form to determine your candidacy for facial rejuvenation procedures. All enquiries remain confidential and will be assessed by Dominic Bray personally.

How did you find us?(Required)
Ideal timeframe for procedure:(Required)
What procedures are you interested in? Tick all that apply(Required)
Medical history
Do any of the following apply?
Facial treatment history
Have you previously undergone any of the following treatments?
Social history(Required)
If another party is involved in your decision making are they already supportive?
Important occasion(Required)
Do you have an important occasion to be ready for?
What area(s) concern you and what would you like to achieve?
If there is any further information you wish to share that is relevant to your enquiry, please provide details in the space provided.

Please upload images of yourself in the following views.

  • Left profile flexed neck

  • Left profile

  • Left 3/4 profile

  • Front view

  • Right 3/4 profile

  • Right profile

  • Right profile flexed neck

Total size of image attachments must not exceed 20mb
Drop files here or
Accepted file types: jpg, jpeg, Max. file size: 20 MB, Max. files: 7.
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