New patient

Create your account.

This creates your patient chart as well as your login, so your history is in one place from the first visit. Nothing here is charged, and no payment details are collected.

Your details

First name

Middle name

Last name

Date of birth

Under 18 — a parent or guardian will need to countersign at your first visit.

Sex

Marital status

Nationality

Religion

Occupation

Mobile number

Email address

Street address

City / municipality

Province

Do you hold an HMO card?

Referred by

Medical and personal history

Optional now, but it saves time at your first visit — and the allergy question is the one your doctor will check before any anaesthetic.

Do you have any other illness?

None Yes

Any previous surgery or procedure — cosmetic or non-cosmetic, lasers, injectables?

None Yes

Are you currently taking any medication, including supplements?

None Yes

Do you have any allergies?

None Yes

Do you smoke (cigarette or vape)?

Do you drink alcohol?

Skin products you are using

Soap, lotion, cosmetics. Kept apart for face and body, because a reaction is traced back to one or the other.

Face

Body

Family medical history

Do any of your family members or immediate relatives have any of the following?

Skin conditions Heart disease Cancer Diabetes Liver disease Kidney disease High blood pressure Asthma

Others

Your sign-in

Password

At least 8 characters, with a letter and a number.

Confirm password

Email me appointment confirmations and reminders I agree to the clinic privacy notice and to my details being held as part of my medical record.

Already registered? Sign in

No online payment

This site never asks for card or bank details. Treatments are paid at the clinic and pickup orders at the counter.