Laser House
ΙΑΤΡΕΙΟ LASER ΑΠΟΤΡΙΧΩΣΗΣ
NEW PATIENT FORM
ENGLISH
GREEK
Patients Name
Email
contact number
Clinic center
Kolonaki
Glyfada
Allergies
Yes
No
Pregnancy / Lactation
Yes
No
Burn History
Yes
No
Open Wounds (acne, psoriasis, eczema, infections in the area)
Yes
No
other info
SUBMIT