Client
consent forms.

Complete the relevant form before your first treatment. Stored securely on file, with a copy emailed to our team and to you.

Choose your form Questions? Call 020 3621 3278

The reception desk at Sorellina Clinic, with practitioner certificates on the wall

Seven formsSigned onlineStored securely

Choose your form.

Pick the treatment you are booked in for, fill in the form and sign at the bottom. Laser appointments also need a free patch test at least 48 hours before your first session.

Laser hair removal & IPL consent form

Complete before your first laser or IPL treatment. A free patch test must be completed at least 48 hours before your first session.

marks a required field

Personal information

Full Name *

Date of Birth *

Email *

Phone

Treatment Area(s)

Practitioner

Medical history: tick all that apply

Pregnant / breastfeeding Epilepsy Active skin infection Photosensitive condition History of keloid scarring Photosensitive medication Recent sun / tan (2 wks) Skin cancer / history of Pacemaker / metal implants Autoimmune condition Blood thinning medication Roaccutane (last 6 months)

Current medications

Known allergies

Consent declaration

I confirm all information provided is accurate and complete.

I understand laser/IPL carries potential risks including temporary redness, swelling and pigment changes.

I agree to follow all pre and post-treatment care instructions provided.

I understand a patch test is required at least 48 hours before my first session.

I confirm I am 18 years of age or over (or parental consent has been obtained).

I consent to Sorellina Clinic storing this information securely in line with GDPR.

Signature

Sign using mouse or finger

Type your full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Laser consent form submitted. Please bring photo ID to your appointment.

Anti-wrinkle consent form

Required before any anti-wrinkle injection. All injectable treatments by Nima, our qualified practitioner.

marks a required field

Full Name *

Date of Birth *

Email *

Treatment Area(s)

Medical history: tick all that apply

Pregnant / breastfeeding Neuromuscular disorder Allergy to botulinum toxin Bleeding disorders Blood thinning medications Antibiotics (last 2 weeks) Autoimmune condition Dental work (last 2 weeks) Herpes simplex / cold sores

Consent declaration

I understand this is a medical procedure. I am aware of risks including bruising, swelling, asymmetry and ptosis.

Effects are temporary (3–6 months). A free top-up is available at 2 weeks. I confirm I am 18+ and consent to GDPR data storage.

Signature

Sign using mouse or finger

Type your full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Anti-wrinkle consent form submitted.

Dermal filler consent form

Required before any filler treatment. A medical procedure requiring fully informed consent.

marks a required field

Full Name *

Email *

Treatment Area(s)

Medical history: tick all that apply

Pregnant / breastfeeding Allergy to hyaluronic acid Allergy to lidocaine Active cold sore / herpes Blood thinning medication Autoimmune condition Recent dental work (4 wks) Roaccutane (last 6 months)

Consent declaration

I understand fillers are temporary (6–18 months) and carry risks including vascular occlusion. I consent to emergency dissolution if clinically necessary.

I confirm I am 18+ and give this consent freely. I agree to GDPR data storage.

Signature

Sign using mouse or finger

Full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Filler consent form submitted.

Skin booster consent form

Profhilo Structra, Polynucleotides, Jalupro, Mesotherapy, Sunekos and all skin booster injections.

marks a required field

Full Name *

Email *

Treatment

Consent declaration

I understand multiple sessions are recommended and results vary.

I confirm I am 18+ and consent freely. I agree to GDPR data storage.

Signature

Sign using mouse or finger

Full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Skin booster consent form submitted.

Facial & skin treatment consent form

Covers Hydra Facials, microneedling, peels and all advanced skin treatments.

marks a required field

Full Name *

Email *

Treatment

Consent declaration

I understand treatments may cause temporary redness or mild irritation and agree to follow aftercare advice.

I consent to this treatment and GDPR data storage.

Signature

Sign using mouse or finger

Full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Facial consent form submitted.

Nail & beauty consent form

All nail services, waxing, threading, lash/brow, microblading and permanent makeup.

marks a required field

Full Name *

Email *

Treatment

Consent declaration

I have disclosed all relevant health conditions. A patch test may be required. I consent to GDPR data storage.

Signature

Sign using mouse or finger

Full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Nail & beauty consent form submitted.

Hair service consent form

Colour, bleaching, keratin, Brazilian blow dry, extensions. Patch test required 48 hours before colour for new clients.

marks a required field

Full Name *

Email *

Service Required

Recent chemical treatments

Consent declaration

I confirm the information is accurate and consent to this service and GDPR data storage.

Signature

Sign using mouse or finger

Full name *

Securely stored on file · A copy is emailed to our team and to you

Received. Hair services consent form submitted.

Sorellina Clinic shopfront at 211 Shirland Road, Maida Vale

Come and
see us.

211 Shirland Road, Maida Vale, London W9 3JP · a short walk from Warwick Avenue station

Book a visit

OpenMon–Sat 10–7 · Sun 12–5

211 Shirland Road
Maida Vale, London W9 3JP

Nearest tube: Warwick Avenue.

020 3621 3278 support@sorellinaclinic.com

Monday	10am – 7pm
Tuesday	10am – 7pm
Wednesday	10am – 7pm
Thursday	10am – 7pm
Friday	10am – 7pm
Saturday	10am – 7pm
Sunday	12pm – 5pm

Clientconsent forms.

Choose your form.

Laser hair removal & IPL consent form

Anti-wrinkle consent form

Dermal filler consent form

Skin booster consent form

Facial & skin treatment consent form

Nail & beauty consent form

Hair service consent form

Come andsee us.

Client
consent forms.

Come and
see us.