Documents for NEW patients
"Quality information, informed decision, safe treatments, more confidence."
Dr Bela's Clinic at The Hogarth Medispa, Chiswick, Airedale Avenue W4 2NW. T: 020 7111 0874
Dermatology - Skin issues
Mole check - skin cancer screening
Botox injections - anti-wrinkle treatments
Dermal Fillers - cheeks, chin, jawline, lips, temple
Thermavein treatment
By downloading and printing the forms at home can decrease the risk of infection.
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Download and Fill out the MEDICAL QUNNAIRE
If you don't feel healthy OR you are vulnerable to COVID 19 infection (over 65 and having chronic health conditions), please cancel your appointment. No cancellation fee applies.
If You are Coming for DERMATOLOGY CONSULTATION*
If You are Coming for MOLE CHECK*
Download and Sign the PHOTOGRAPHY CONSENT
If You are Coming for BOTOX*
Download and Read the BOTOX INFORMATION
Download and Sign the BOTOX CONSENT
If You are Coming for FILLERS*
Download and Read the FILLER INFORMATION
Download and Sign the FILLER CONSENT
Any questions, write to info@drbela.clinic
If You are Coming for Aesthetic Consultation*
Download and Fill out the Interest QUNNAIRE - Male
Download and Fill out the Interest QUNNAIRE - Female
*If You cannot sort out printing this document you can fill it out at the clinic
(not optimal but possible)
*It is important to arrive to your appointment with the Medical Form filled out.
The Consent form is optional.
If You are Coming for PODIART custom insoles*
Bring the pair of shoes where the insoles go
Ensure that the factory insoles are removable!