1 Personal Details

Virtual Consent Form

Thank you for responding to the virtual questionnaire which helps us to prepare for your consultation.

We look forward to our journey together.

Kindly send us your consent below prior to our consultation session.

I, hereby consent to a Virtual Online Consultation with you and agree for the consultation to be recorded and kept in my personal record file online should we ever need to refer back to it. 

I am aware that the consultation and all information shared with you is confidential and will not be shared with anyone unless approved by both parties in writing.

I confirm that I have answered all questions honestly and to the best of my ability and that I will inform Canvas Aesthetics regarding any current or past medical condition, disease or medication taken.

I understand that the consultation will accompany a full, customized and recommended product and / or treatment plan for my needs which may include lifestyle or application tips which I can choose to follow, should I wish. 

I, confirm that my Virtual Online Consultation is booked for:

Full Time:
I consent: