{"id":1600,"date":"2025-11-21T12:47:40","date_gmt":"2025-11-21T12:47:40","guid":{"rendered":"https:\/\/eleganzaaesthetics.co.uk\/?page_id=1600"},"modified":"2026-06-05T16:06:35","modified_gmt":"2026-06-05T16:06:35","slug":"booking","status":"publish","type":"page","link":"https:\/\/eleganzaaesthetics.co.uk\/fa\/booking\/","title":{"rendered":"Booking"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1600\" class=\"elementor elementor-1600\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-94befe4 e-flex e-con-boxed e-con e-parent\" data-id=\"94befe4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d356a89 elementor-widget elementor-widget-stepbooking\" data-id=\"d356a89\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"stepbooking.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n<script>\n  if (typeof hasAmeliaEntitiesApiCall === 'undefined' && ('' === '' && '' === '' && '' !== '1')) {\n    var hasAmeliaEntitiesApiCall = true;\n  }\n  var ameliaShortcodeData = (typeof ameliaShortcodeData === 'undefined') ? 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Consent Form - Medical Declaration<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/fa\/wp-json\/wp\/v2\/pages\/1600' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_8_1\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_1'>Complete Your Consent Form<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_8_1' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Chose Your Treatment' >Chose Your Treatment<\/option><option value='Anti Wrinkle ( Botox )' >Anti Wrinkle ( Botox )<\/option><option value='Dermal Fillers' >Dermal Fillers<\/option><option value='Fat Dissolving' >Fat Dissolving<\/option><option value='Microneedling' >Microneedling<\/option><option value='RF Microneedling' >RF Microneedling<\/option><option value='Skin Boosters' >Skin Boosters<\/option><option value='Filler Dissolving' >Filler Dissolving<\/option><option value='PDO Thread Lift' >PDO Thread Lift<\/option><\/select><\/div><\/div><div id=\"field_8_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Choose Your Treatment<\/h3><\/div><div id=\"field_8_3\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Anti Wrinkle ( Botox )<\/h3><\/div><div id=\"field_8_93\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"antiWrinkleDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Anti-Wrinkle Injections Consent Form<\/strong><br><br>\n\nThis is an informed consent document that has been prepared to help inform you concerning Anti-Wrinkle injections and the risks involved. It is important that you read this information carefully and completely.<br><br>\n\nPlease complete each section, indicating that you have read the page and sign the consent at the bottom prior to your treatment.<br><br>\n\n<b>INTRODUCTION:<\/b><br>\nAnti-Wrinkle injections involve a series of small injections in order to weaken the chosen muscles. The weakening of the injected muscles begins to be apparent after 2-3 days with the peak effect being reached after 10-14 days. Results can last 3-6 months. The procedure can be repeated after 3 months; however, injections given less than 3-month intervals may reduce efficacy.<br><br>\n\n<b>RISKS OF ANTI-WRINKLE INJECTIONS:<\/b><br>\nEvery procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual's choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your practitioner to make sure you understand the risks, potential complications, and consequences of Anti-Wrinkle injections:<br>\n- Bleeding<br>\n- Bruising\/Swelling<br>\n- Infection<br>\n- Unsatisfactory Outcome\/Temporary loss of function of nearby muscles<br><br>\n\n<b>PUBLICITY MATERIALS:<\/b><br>\nI authorize the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the practitioner harmless for any liability resulting from this production. I waive my rights to any royalties, fees, and to inspect the finished production as well as advertising materials in conjunction with these photographs.<br><br>\n\nYou certify by signing this form that you have read the information in this document and completely understand it. You choose to proceed based entirely on the information provided in this informed consent document. You have been given all the necessary opportunities for discussion and all your questions regarding anti-wrinkle injections have been answered. You therefore and hereby consent to the care or treatment described herein.<br><br>\n\nAny discrepancies must be taken up with the practitioner within 1 month of treatment.\n<\/p>\n<\/div>\n\n<span id=\"toggleAntiWrinkle\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleAntiWrinkle\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"antiWrinkleDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script><\/div><fieldset id=\"field_8_111\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_111.1' id='input_8_111_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_111_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_111.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_111.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_12\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1.\tAre you currently pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_12'>\n\t\t\t<div class='gchoice gchoice_8_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='YES'  id='choice_8_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_12_0' id='label_8_12_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='NO'  id='choice_8_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_12_1' id='label_8_12_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_26'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_8_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_15\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2.\tHave you ever had an allergic reaction to botulinum toxin (or similar)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_15'>\n\t\t\t<div class='gchoice gchoice_8_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='YES'  id='choice_8_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_15_0' id='label_8_15_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='NO'  id='choice_8_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_15_1' id='label_8_15_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_27'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_8_27' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_25\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3.\tDo you have any neuromuscular or nerve\/muscle disorders (e.g. Myasthenia Gravis)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_25'>\n\t\t\t<div class='gchoice gchoice_8_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='YES'  id='choice_8_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_25_0' id='label_8_25_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='NO'  id='choice_8_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_25_1' id='label_8_25_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_28'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_8_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_24\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4.\tAre you taking any antibiotics, muscle\u2011relaxants or medicines that affect nerves\/muscles?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_24'>\n\t\t\t<div class='gchoice gchoice_8_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='YES'  id='choice_8_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_24_0' id='label_8_24_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='NO'  id='choice_8_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_24_1' id='label_8_24_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_29'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_8_29' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_23\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5.\tDo you take any blood thinners, anticoagulants or medications that affect bleeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_23'>\n\t\t\t<div class='gchoice gchoice_8_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='YES'  id='choice_8_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_23_0' id='label_8_23_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='NO'  id='choice_8_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_23_1' id='label_8_23_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_30'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_8_30' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_22\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6.\tHave you had Botox or any neurotoxin treatment in the last 3 months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_22'>\n\t\t\t<div class='gchoice gchoice_8_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='YES'  id='choice_8_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_22_0' id='label_8_22_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='NO'  id='choice_8_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_22_1' id='label_8_22_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_31'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_8_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_21\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7.\tDo you currently have an infection, rash, cold sore or skin lesion in the planned treatment area?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_21'>\n\t\t\t<div class='gchoice gchoice_8_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='YES'  id='choice_8_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_21_0' id='label_8_21_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='NO'  id='choice_8_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_21_1' id='label_8_21_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_32'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_8_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_20\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8.\tHave you experienced excessive bruising or delayed healing from previous injections or skin procedures?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_20'>\n\t\t\t<div class='gchoice gchoice_8_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='YES'  id='choice_8_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_20_0' id='label_8_20_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='NO'  id='choice_8_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_20_1' id='label_8_20_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_33'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_8_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_19\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9.\tDo you have any chronic illness (e.g. autoimmune, thyroid, diabetes) you are being treated for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_19'>\n\t\t\t<div class='gchoice gchoice_8_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='YES'  id='choice_8_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_19_0' id='label_8_19_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='NO'  id='choice_8_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_19_1' id='label_8_19_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_34'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_8_34' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_18\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10.\tAre you allergic to lidocaine or other local anaesthetics?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_18'>\n\t\t\t<div class='gchoice gchoice_8_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='YES'  id='choice_8_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_18_0' id='label_8_18_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='NO'  id='choice_8_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_18_1' id='label_8_18_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_36'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_8_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_17\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Do you understand and accept that mild post-treatment side effects may occur (swelling, bruising, headache, or temporary muscle weakness), which can last approximately 3 - 7 days depending on individual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_17'>\n\t\t\t<div class='gchoice gchoice_8_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='YES'  id='choice_8_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_17_0' id='label_8_17_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='NO'  id='choice_8_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_17_1' id='label_8_17_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_37'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_8_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_16\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >12.\tDo you consent to photographs of the treatment area (before\/after) for clinical documentation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_16'>\n\t\t\t<div class='gchoice gchoice_8_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='YES'  id='choice_8_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_16_0' id='label_8_16_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='NO'  id='choice_8_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_16_1' id='label_8_16_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_39\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_39'>\n                            \n                            <span id='input_8_39_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.3' id='input_8_39_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_39_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_39_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.6' id='input_8_39_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_39_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_38\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_38'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_38' id='input_8_38_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_38_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_38' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_38_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_38_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_38_data' name='input_8_38_data' value=''><\/div><\/div><fieldset id=\"field_8_40\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_40.1' id='input_8_40_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_40_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_40.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_40.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dermal Fillers<\/h3><\/div><div id=\"field_8_96\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"dermalFillerDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Client Disclaimer for Dermal Filler<\/strong><br><br>\n\n<b>PATIENT CONSENT:<\/b> This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of dermal filler injections. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.<br><br>\n\nIt is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. You are encouraged to ask any questions that come to mind throughout the entirety of the process.<br><br>\n\n<b>INTRODUCTION:<\/b><br>\nInjection of dermal fillers aims to smooth out facial folds and wrinkles, add volume to the tissues (e.g., lips), and help contour facial features. Most dermal fillers used are based on Hyaluronic acid and may contain lidocaine, a local anaesthetic to help with pain control.<br><br>\n\n<b>RESULTS:<\/b><br>\nHyaluronic acid dermal fillers have been shown to be safe and effective; results can last up to 12 months or longer. A period of 2 weeks should be allowed for the filler to settle and for bruising and swelling to subside. Additional treatments or top-ups may be required to achieve desired results.<br><br>\n\n<b>RISKS AND COMPLICATIONS:<\/b><br>\nCommon complications include pain, bleeding, bruising, and mild swelling. Uncommon complications include infection, cold sore reactivation, lumps, or nodules. Rare complications include allergic reactions, vascular occlusion, and, very rarely, filler blindness.<br><br>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b><br>\nI agree to and authorise the taking of clinical photographs and videos, which will be kept as part of my confidential medical records.<br><br>\n\nI have been advised of the relevant information associated with this treatment and confirm I fully understand this advice. I certify that I have read the above consent and have had all my questions answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleDermalFiller\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleDermalFiller\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"dermalFillerDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script>\n<\/div><fieldset id=\"field_8_91\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_91.1' id='input_8_91_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_91_1' >I have read the above and agree to it.<\/label><input type='hidden' name='input_91.2' value='I have read the above and agree to it.' class='gform_hidden' \/><input type='hidden' name='input_91.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_41\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_41'>\n\t\t\t<div class='gchoice gchoice_8_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='YES'  id='choice_8_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_41_0' id='label_8_41_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='NO'  id='choice_8_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_41_1' id='label_8_41_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_64'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_8_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_58\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2.\tDo you have known allergies to filler ingredients, lidocaine or anaesthetics used in fillers?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_58'>\n\t\t\t<div class='gchoice gchoice_8_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='YES'  id='choice_8_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_0' id='label_8_58_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='NO'  id='choice_8_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_1' id='label_8_58_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_144\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_144'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_144' id='input_8_144' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_57\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3.\tAre you currently taking blood thinners, anticoagulants or anti\u2011inflammatory medications (e.g. aspirin, ibuprofen)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_57'>\n\t\t\t<div class='gchoice gchoice_8_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='YES'  id='choice_8_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_57_0' id='label_8_57_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='NO'  id='choice_8_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_57_1' id='label_8_57_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_67'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_8_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_56\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4.\tDo you have a history of abnormal scarring, keloids, or poor wound healing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_56'>\n\t\t\t<div class='gchoice gchoice_8_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='YES'  id='choice_8_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_56_0' id='label_8_56_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='NO'  id='choice_8_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_56_1' id='label_8_56_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_66'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_8_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_55\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5.\tHave you used isotretinoin (Accutane) in the last 12 months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_55'>\n\t\t\t<div class='gchoice gchoice_8_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='YES'  id='choice_8_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_55_0' id='label_8_55_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='NO'  id='choice_8_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_55_1' id='label_8_55_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_222\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_222'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_222' id='input_8_222' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_54\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6.\tDo you have any active skin infections, cold sores or lesions in the area to be treated?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_54'>\n\t\t\t<div class='gchoice gchoice_8_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='YES'  id='choice_8_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_54_0' id='label_8_54_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='NO'  id='choice_8_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_54_1' id='label_8_54_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_69'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_8_69' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_53\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7.\tHave you had cosmetic skin treatments (laser, peels, other injectables) in the last 4\u20136 weeks?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_53'>\n\t\t\t<div class='gchoice gchoice_8_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='YES'  id='choice_8_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_53_0' id='label_8_53_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='NO'  id='choice_8_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_53_1' id='label_8_53_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_71'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_8_71' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_51\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8.\tDo you understand and accept the possible risks: bruising, swelling, asymmetry, nodules or lumps, delayed reaction, infection, vascular complications (rare but serious)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_51'>\n\t\t\t<div class='gchoice gchoice_8_51_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='YES'  id='choice_8_51_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_51_0' id='label_8_51_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_51_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='NO'  id='choice_8_51_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_51_1' id='label_8_51_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_50\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9.\tAre you aware the filler results may not be permanent and may require touch\u2011ups or dissolving?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_50'>\n\t\t\t<div class='gchoice gchoice_8_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='YES'  id='choice_8_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_50_0' id='label_8_50_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='NO'  id='choice_8_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_50_1' id='label_8_50_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_49\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Do you give permission for your before-and-after photographs to be used for clinical documentation, research, or marketing purposes?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_49'>\n\t\t\t<div class='gchoice gchoice_8_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='YES'  id='choice_8_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_49_0' id='label_8_49_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='NO'  id='choice_8_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_49_1' id='label_8_49_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_62\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Do you fully understand post\u2011treatment aftercare instructions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_62'>\n\t\t\t<div class='gchoice gchoice_8_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='YES'  id='choice_8_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_62_0' id='label_8_62_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='NO'  id='choice_8_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_62_1' id='label_8_62_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_60\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_60'>\n                            \n                            <span id='input_8_60_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_60.3' id='input_8_60_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_60_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_60_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_60.6' id='input_8_60_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_60_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_59\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_59'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_59' id='input_8_59_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_59_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_59' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_59_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_59_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_59_data' name='input_8_59_data' value=''><\/div><\/div><fieldset id=\"field_8_61\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_61.1' id='input_8_61_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_61_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_61.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_61.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Skin Boosters<\/h3><\/div><div id=\"field_8_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.4s ease;\n}\n\n.disclaimer-container.expanded {\n  max-height: 2000px;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"disclaimerBox\" class=\"disclaimer-container\">\n<p><strong>Client Disclaimer for Skin Booster Treatment<\/strong><br><br>\n\n<b>RISKS AND SIDE EFFECTS:<\/b> As with any procedure there are potential risks and complications associated with Skin Boosters Injections. You must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.<br><br>\n\n<b>Common complications:<\/b><br>\nThese include pain, bleeding and bruising at the time of injection. After injection, the area may feel tender but should not be actively painful. If you experience significant pain then you must contact your practitioner as soon as possible for review. Bruising is dependent on several factors, most of the time bruising is mild but occasionally can be more significant. Bruising can take up to 2 weeks to fully resolve but should be much improved after 1 week. More uncommonly severe bruising can lead to haematoma formation, a collection of clotted blood. In this case the swollen collection of blood will need at least 2 weeks to resolve naturally and your practitioner will give you the appropriate after care advice. Your skin may appear red and swollen after the injection, this is usually mild and should improve after a couple of days, but it can last up to 14 days in some cases.<br><br>\n\n<b>Uncommon complications include:<\/b><br>\nSkin infection (cellulitis) which presents as hot, red, shiny skin and you may also be generally unwell. In the case of suspected infection, you should contact your practitioner but also seek medical assessment as soon as possible as you will likely need antibiotics. Occasionally infection can form a swollen collection called an abscess. In this case you again must seek urgent medical attention. If you suffer from cold sores (a herpes virus infection of the lip) these can sometimes be reactivated following injections. Occasionally people can develop an unwanted inflammatory reaction and this can lead to nodule formation called granuloma. These often present as a delayed complication several months after the treatment. Several treatment options are available for granuloma formation and you may require medical assessment. Sometimes people can faint or feel faint with injections, you must tell your practitioner as soon as possible if you feel unwell during the treatment.<br><br>\n\n<b>Rare complications include:<\/b><br>\nAllergic reaction including anaphylactic reaction which would require emergency medical assistance and transfer to hospital. Rarely, it can be injected into an artery blocking the flow of blood to the tissue being treated. This is known as vascular occlusion, if untreated it is serious because it can lead to death of tissue (necrosis) which may require reconstructive surgery to correct. In the rare event of vascular occlusion, it would be treated with emergency injections of a dissolving drug called Hyaluronidase. This is an enzyme that removes the hyaluronic acid occluding the blood vessel and can usually fully reverse the vascular occlusion leading to no long-term harmful effects. Your practitioner will be trained in how to use Hyaluronidase in an emergency, however if treatment with Hyaluronidase is not successful then you would require urgent medical assessment or assessment by a doctor who is a specialist in aesthetic medicine.<br><br>\n\nI understand that several appointments may be necessary to produce optimal results and I will be notified, in advance of each session of treatment, about the location where the next treatment session is going to take place and the identity of who is going to be involved in my care at each stage. I also understand that I will be kept informed of progress and that I can change my mind at any point.<br><br>\n\nI have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:<br>\n- the aims\/motivations for having the procedure and the desired outcome<br>\n- the risks inherent in the procedure<br>\n- the risks inherent in refusing the procedure<br>\n- the risks specific to me<br>\n- the expected benefits of the treatment<br>\n- the potential disadvantages of the treatment<br>\n- alternative procedures and their pros and cons \u2013 including the option of no treatment at all<br>\n- any uncertainties about and the likelihood of success of the procedure<br>\n- any follow-up treatment that may be required<br><br>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b> I agree to and authorise the taking of clinical photographs and videos. I understand that these will form part of my confidential medical records.<br><br>\n\nI certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleBtn\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleBtn\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"disclaimerBox\");\n  box.classList.toggle(\"expanded\");\n  \n  if (box.classList.contains(\"expanded\")) {\n    this.textContent = \"Show Less\";\n  } else {\n    this.textContent = \"Show More\";\n  }\n});\n<\/script>\n<\/div><fieldset id=\"field_8_112\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_112.1' id='input_8_112_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_112_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_112.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_112.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_44\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_44'>\n\t\t\t<div class='gchoice gchoice_8_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='YES'  id='choice_8_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_44_0' id='label_8_44_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='NO'  id='choice_8_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_44_1' id='label_8_44_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_145\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_145'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_145' id='input_8_145' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_110\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_110'>\n\t\t\t<div class='gchoice gchoice_8_110_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='YES'  id='choice_8_110_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_110_0' id='label_8_110_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_110_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='NO'  id='choice_8_110_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_110_1' id='label_8_110_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_146\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_146'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_146' id='input_8_146' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_109\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_109'>\n\t\t\t<div class='gchoice gchoice_8_109_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='YES'  id='choice_8_109_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_109_0' id='label_8_109_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_109_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='NO'  id='choice_8_109_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_109_1' id='label_8_109_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_147'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_8_147' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_108\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_108'>\n\t\t\t<div class='gchoice gchoice_8_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='YES'  id='choice_8_108_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_108_0' id='label_8_108_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='NO'  id='choice_8_108_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_108_1' id='label_8_108_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_149\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_149'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_8_149' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_107\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Do you have any skin conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_107'>\n\t\t\t<div class='gchoice gchoice_8_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='YES'  id='choice_8_107_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_107_0' id='label_8_107_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='NO'  id='choice_8_107_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_107_1' id='label_8_107_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_150\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_150'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_150' id='input_8_150' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_106\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have any known allergies or have ever had anaphylaxis?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_106'>\n\t\t\t<div class='gchoice gchoice_8_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='YES'  id='choice_8_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_106_0' id='label_8_106_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='NO'  id='choice_8_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_106_1' id='label_8_106_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_148\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_148'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_8_148' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_105\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_105'>\n\t\t\t<div class='gchoice gchoice_8_105_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='YES'  id='choice_8_105_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_105_0' id='label_8_105_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_105_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='NO'  id='choice_8_105_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_105_1' id='label_8_105_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_151\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_151'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_151' id='input_8_151' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_104\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_104'>\n\t\t\t<div class='gchoice gchoice_8_104_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_104' type='radio' value='YES'  id='choice_8_104_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_104_0' id='label_8_104_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_104_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_104' type='radio' value='NO'  id='choice_8_104_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_104_1' id='label_8_104_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_152\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_152'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_152' id='input_8_152' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_103\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Is there any other Medical and\/or Social History that we should know? If so, please provide full detail here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_103'>\n\t\t\t<div class='gchoice gchoice_8_103_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_103' type='radio' value='YES'  id='choice_8_103_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_103_0' id='label_8_103_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_103_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_103' type='radio' value='NO'  id='choice_8_103_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_103_1' id='label_8_103_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_153\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_153'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_153' id='input_8_153' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_102\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_102'>\n\t\t\t<div class='gchoice gchoice_8_102_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='YES'  id='choice_8_102_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_102_0' id='label_8_102_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_102_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='NO'  id='choice_8_102_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_102_1' id='label_8_102_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_154\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_154'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_154' id='input_8_154' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_101\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Do you understand and accept that mild post-treatment side effects may occur (swelling, bruising, headache, or temporary muscle weakness), which can last approximately 3 - 7 days depending on individual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_101'>\n\t\t\t<div class='gchoice gchoice_8_101_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='YES'  id='choice_8_101_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_101_0' id='label_8_101_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_101_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='NO'  id='choice_8_101_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_101_1' id='label_8_101_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_84\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_84'>\n                            \n                            <span id='input_8_84_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_84.3' id='input_8_84_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_84_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_84_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_84.6' id='input_8_84_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_84_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_72\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_72'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_72' id='input_8_72_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_72_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_72' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_72_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_72_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_72_data' name='input_8_72_data' value=''><\/div><\/div><fieldset id=\"field_8_79\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_79.1' id='input_8_79_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_79_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_79.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_79.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Microneedling<\/h3><\/div><div id=\"field_8_99\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"microneedlingDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Patient Consent \u2013 Microneedling<\/strong><br><br>\n\n<b>PATIENT CONSENT:<\/b> This is an informed consent form to help inform you of the potential benefits and risks of microneedling. You must read this carefully and discuss fully with your practitioner before proceeding.<br><br>\n\nMicroneedling is a skin treatment used to rejuvenate the skin and improve its surface. It can improve fine lines, wrinkles, enlarged pores, acne scars, hyperpigmentation, and stretch marks. The device creates small punctures in the epidermis, triggering collagen synthesis and allowing healing serums to penetrate. Topical anaesthetic is applied for comfort. Healing gels or PRP may be used. Treatments typically take 30\u201360 minutes.<br><br>\n\nMultiple sessions may be required for optimal results. Results are seen in 2\u20133 weeks, peaking at 4\u20136 weeks. Duration varies per client and results are not guaranteed. Microneedling does not prevent recurrence of the condition treated.<br><br>\n\n<b>RISKS AND SIDE EFFECTS:<\/b><br>\nAs with any procedure, there are possible risks. Discuss all concerns with your practitioner.<br><br>\n\n<b>Common side effects:<\/b> Discomfort or stinging during\/after treatment, tightness, swelling, redness, tenderness. Usually resolves within 7 days. Bruising may occur; fainting is possible in some cases.<br><br>\n\n<b>Uncommon side effects:<\/b> Skin infection (cellulitis), reactivation of cold sores, hyperpigmentation or hypopigmentation. Usually resolves within 6 months, rarely permanent. Risk is higher for tanned or darker skin tones. Follow pre- and post-care instructions and sun protection.<br><br>\n\n<b>Rare side effects:<\/b> Permanent scarring.<br><br>\n\nI understand that multiple appointments may be required and I will be informed of the location and personnel involved in each session. I can change my mind at any point.<br><br>\n\nI confirm I fully understand the advice given, including:<br>\n- Treatment aims and desired outcomes<br>\n- Risks inherent in treatment and refusing it<br>\n- Expected benefits and potential disadvantages<br>\n- Alternative options including no treatment<br>\n- Likelihood of success and any follow-up needed<br><br>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b> I authorise photographs\/videos for my confidential medical records.<br><br>\n\nI certify that I have read, fully understand, and consent to this procedure. This supersedes any previous disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleMicroneedling\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleMicroneedling\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"microneedlingDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script>\n<\/div><fieldset id=\"field_8_113\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_113.1' id='input_8_113_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_113_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_113.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_113.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_100\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_100'>\n\t\t\t<div class='gchoice gchoice_8_100_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='YES'  id='choice_8_100_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_100_0' id='label_8_100_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_100_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='NO'  id='choice_8_100_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_100_1' id='label_8_100_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_155\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_155'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_8_155' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_125\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_125'>\n\t\t\t<div class='gchoice gchoice_8_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='YES'  id='choice_8_125_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_125_0' id='label_8_125_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='NO'  id='choice_8_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_125_1' id='label_8_125_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_156\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_156'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_156' id='input_8_156' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_124\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_124'>\n\t\t\t<div class='gchoice gchoice_8_124_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='YES'  id='choice_8_124_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_124_0' id='label_8_124_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_124_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='NO'  id='choice_8_124_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_124_1' id='label_8_124_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_157\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_157'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_8_157' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_122\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_122'>\n\t\t\t<div class='gchoice gchoice_8_122_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='YES'  id='choice_8_122_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_122_0' id='label_8_122_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_122_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='NO'  id='choice_8_122_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_122_1' id='label_8_122_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_158\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_158'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_158' id='input_8_158' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_123\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Do you have any skin conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_123'>\n\t\t\t<div class='gchoice gchoice_8_123_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='YES'  id='choice_8_123_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_123_0' id='label_8_123_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_123_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='NO'  id='choice_8_123_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_123_1' id='label_8_123_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_159\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_159'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_159' id='input_8_159' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_121\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have any known allergies or have ever had anaphylaxis?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_121'>\n\t\t\t<div class='gchoice gchoice_8_121_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='YES'  id='choice_8_121_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_121_0' id='label_8_121_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_121_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='NO'  id='choice_8_121_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_121_1' id='label_8_121_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_160\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_160'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_160' id='input_8_160' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_120\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_120'>\n\t\t\t<div class='gchoice gchoice_8_120_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='YES'  id='choice_8_120_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_120_0' id='label_8_120_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_120_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='NO'  id='choice_8_120_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_120_1' id='label_8_120_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_161\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_161'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_161' id='input_8_161' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_119\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_119'>\n\t\t\t<div class='gchoice gchoice_8_119_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='YES'  id='choice_8_119_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_119_0' id='label_8_119_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_119_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='NO'  id='choice_8_119_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_119_1' id='label_8_119_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_162\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_162'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_162' id='input_8_162' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_118\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Is there any other Medical and\/or Social History that we should know? If so, please provide full detail here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_118'>\n\t\t\t<div class='gchoice gchoice_8_118_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_118' type='radio' value='YES'  id='choice_8_118_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_118_0' id='label_8_118_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_118_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_118' type='radio' value='NO'  id='choice_8_118_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_118_1' id='label_8_118_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_163\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_163'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_8_163' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_117\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_117'>\n\t\t\t<div class='gchoice gchoice_8_117_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='YES'  id='choice_8_117_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_117_0' id='label_8_117_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_117_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='NO'  id='choice_8_117_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_117_1' id='label_8_117_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_166\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_166'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_8_166' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_165\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Do you understand and accept that mild post-treatment side effects may occur (swelling, bruising, headache, or temporary muscle weakness), which can last approximately 3 - 7 days depending on individual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_165'>\n\t\t\t<div class='gchoice gchoice_8_165_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_165' type='radio' value='YES'  id='choice_8_165_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_165_0' id='label_8_165_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_165_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_165' type='radio' value='NO'  id='choice_8_165_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_165_1' id='label_8_165_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_164\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_164'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_164' id='input_8_164' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_83\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_83'>\n                            \n                            <span id='input_8_83_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_83.3' id='input_8_83_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_83_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_83_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_83.6' id='input_8_83_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_83_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_73\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_73'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_73' id='input_8_73_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_73_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_73' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_73_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_73_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_73_data' name='input_8_73_data' value=''><\/div><\/div><fieldset id=\"field_8_80\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_80.1' id='input_8_80_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_80_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_80.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_80.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">RF Microneedling<\/h3><\/div><div id=\"field_8_97\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"rfMicroneedlingDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Patient Consent \u2013 RF Microneedling<\/strong><br><br>\n\n<b>PATIENT CONSENT:<\/b> This is an informed consent form to help inform you of the potential benefits and risks of RF microneedling. You must read this carefully and discuss fully with your practitioner before proceeding.<br><br>\n\nRF Microneedling is a skin treatment combining microneedling with radiofrequency energy to stimulate collagen and tighten skin. It improves fine lines, wrinkles, acne scars, enlarged pores, hyperpigmentation, and skin laxity. The device delivers controlled RF energy via fine needles into the dermis, promoting tissue remodeling. Topical anaesthetic is applied for comfort. Treatments typically take 30\u201360 minutes and may include healing gels or serums.<br><br>\n\nMultiple sessions may be required for optimal results. Improvements are generally noticeable in 2\u20133 weeks, with peak results at 4\u20136 weeks. Duration varies per client, and results are not guaranteed. RF Microneedling does not prevent recurrence of the condition treated.<br><br>\n\n<b>RISKS AND SIDE EFFECTS:<\/b><br>\nAs with any procedure, there are possible risks. Discuss all concerns with your practitioner.<br><br>\n\n<b>Common side effects:<\/b> Mild discomfort, stinging, redness, swelling, tenderness, or tightness immediately after treatment. Usually resolves within 7 days. Bruising may occur; fainting is possible in some cases.<br><br>\n\n<b>Uncommon side effects:<\/b> Skin infection (cellulitis), reactivation of cold sores, hyperpigmentation or hypopigmentation, temporary numbness, minor burns or redness. Usually resolves within 6 months, rarely permanent. Risk is higher for tanned or darker skin tones. Follow pre- and post-care instructions and sun protection.<br><br>\n\n<b>Rare side effects:<\/b> Permanent scarring, prolonged redness, or adverse reactions to RF energy.<br><br>\n\nI understand that multiple appointments may be required and I will be informed of the location and personnel involved in each session. I can change my mind at any point.<br><br>\n\nI confirm I fully understand the advice given, including:<br>\n- Treatment aims and desired outcomes<br>\n- Risks inherent in treatment and refusing it<br>\n- Expected benefits and potential disadvantages<br>\n- Alternative options including no treatment<br>\n- Likelihood of success and any follow-up needed<br><br>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b> I authorise photographs\/videos for my confidential medical records.<br><br>\n\nI certify that I have read, fully understand, and consent to this procedure. This supersedes any previous disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleRFMicroneedling\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleRFMicroneedling\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"rfMicroneedlingDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script>\n<\/div><fieldset id=\"field_8_114\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_114.1' id='input_8_114_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_114_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_114.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_114.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_43\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_43'>\n\t\t\t<div class='gchoice gchoice_8_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='YES'  id='choice_8_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_43_0' id='label_8_43_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='NO'  id='choice_8_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_43_1' id='label_8_43_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_167'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_8_167' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_45\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_45'>\n\t\t\t<div class='gchoice gchoice_8_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='YES'  id='choice_8_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_45_0' id='label_8_45_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='NO'  id='choice_8_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_45_1' id='label_8_45_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_168\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_168'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_8_168' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_126\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_126'>\n\t\t\t<div class='gchoice gchoice_8_126_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='YES'  id='choice_8_126_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_126_0' id='label_8_126_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_126_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='NO'  id='choice_8_126_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_126_1' id='label_8_126_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_170\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_170'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_170' id='input_8_170' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_127\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_127'>\n\t\t\t<div class='gchoice gchoice_8_127_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='YES'  id='choice_8_127_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_127_0' id='label_8_127_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_127_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='NO'  id='choice_8_127_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_127_1' id='label_8_127_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_169\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_169'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_169' id='input_8_169' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_133\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Do you have any skin conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_133'>\n\t\t\t<div class='gchoice gchoice_8_133_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='YES'  id='choice_8_133_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_133_0' id='label_8_133_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_133_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='NO'  id='choice_8_133_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_133_1' id='label_8_133_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_171\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_171'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_171' id='input_8_171' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_132\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have any known allergies or have ever had anaphylaxis?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_132'>\n\t\t\t<div class='gchoice gchoice_8_132_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='YES'  id='choice_8_132_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_132_0' id='label_8_132_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_132_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='NO'  id='choice_8_132_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_132_1' id='label_8_132_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_172\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_172'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_172' id='input_8_172' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_131\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_131'>\n\t\t\t<div class='gchoice gchoice_8_131_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='YES'  id='choice_8_131_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_131_0' id='label_8_131_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_131_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='NO'  id='choice_8_131_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_131_1' id='label_8_131_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_173\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_173'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_173' id='input_8_173' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_128\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_128'>\n\t\t\t<div class='gchoice gchoice_8_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='YES'  id='choice_8_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_128_0' id='label_8_128_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='NO'  id='choice_8_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_128_1' id='label_8_128_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_175\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_175'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_175' id='input_8_175' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_130\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Is there any other Medical and\/or Social History that we should know? If so, please provide full detail here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_130'>\n\t\t\t<div class='gchoice gchoice_8_130_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='YES'  id='choice_8_130_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_130_0' id='label_8_130_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_130_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='NO'  id='choice_8_130_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_130_1' id='label_8_130_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_174\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_174'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_174' id='input_8_174' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_129\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_129'>\n\t\t\t<div class='gchoice gchoice_8_129_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='YES'  id='choice_8_129_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_129_0' id='label_8_129_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_129_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='NO'  id='choice_8_129_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_129_1' id='label_8_129_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_178\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_178'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_178' id='input_8_178' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_177\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Do you understand and accept that mild post-treatment side effects may occur (swelling, bruising, headache, or temporary muscle weakness), which can last approximately 3 - 7 days depending on individual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_177'>\n\t\t\t<div class='gchoice gchoice_8_177_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_177' type='radio' value='YES'  id='choice_8_177_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_177_0' id='label_8_177_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_177_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_177' type='radio' value='NO'  id='choice_8_177_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_177_1' id='label_8_177_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_176\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_176'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_176' id='input_8_176' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_82\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_82'>\n                            \n                            <span id='input_8_82_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.3' id='input_8_82_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_82_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_82_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.6' id='input_8_82_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_82_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_74\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_74'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_74' id='input_8_74_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_74_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_74' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_74_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_74_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_74_data' name='input_8_74_data' value=''><\/div><\/div><fieldset id=\"field_8_78\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_78.1' id='input_8_78_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_78_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_78.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_78.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Fat Dissolving<\/h3><\/div><div id=\"field_8_98\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"lemonBottleDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Client Disclaimer for Lemon Bottle Fat Dissolving Treatment<\/strong><br><br>\n\n<b>Product Information:<\/b><br>\nThe Lemon Bottle is an aesthetic treatment product designed specifically for fat dissolution. It involves a solution that is injected into fat pockets to facilitate fat breakdown and enhance the body's natural fat removal processes.<br><br>\n\n<b>Treatment Information:<\/b><br>\nThe treatment involves the injection of the Lemon Bottle solution into specified areas of fat accumulation. It is a non-surgical procedure performed by a licensed practitioner. Procedure duration and number of sessions required may vary based on individual needs and the amount of fat to be dissolved.<br><br>\n\n<b>Potential Risks:<\/b><br>\nWhile generally considered safe, potential risks include:\n<ul>\n<li>Localised pain, swelling, redness or bruising at the injection site<\/li>\n<li>Potential for an allergic reaction to the product<\/li>\n<li>Possibility of infection if aftercare instructions are not properly followed<\/li>\n<li>Temporary changes to skin texture or irregularities in body contour<\/li>\n<li>In rare instances, more serious complications may arise<\/li>\n<\/ul>\n\n<b>Benefits:<\/b><br>\nPotential benefits include reduction of localised fat pockets, improvement in body contour, and enhancement in overall body appearance.<br><br>\n\nI have been advised of the relevant information associated with this treatment and I confirm I fully understand this advice. This includes:\n<ul>\n<li>The aims\/motivations for having the procedure and the desired outcome<\/li>\n<li>The risks inherent in the procedure<\/li>\n<li>The risks inherent in refusing the procedure<\/li>\n<li>The risks specific to me<\/li>\n<li>The expected benefits of the treatment<\/li>\n<li>The potential disadvantages of the treatment<\/li>\n<li>Alternative procedures and their pros and cons \u2013 including the option of no treatment at all<\/li>\n<li>Any uncertainties about and the likelihood of success of the procedure<\/li>\n<li>Any follow-up treatment that may be required<\/li>\n<\/ul>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b><br>\nI agree to and authorise the taking of clinical photographs and videos. I understand that these will form part of and will be kept with my confidential medical records.<br><br>\n\nI certify that I have read the above consent, fully understand it, and have had all my questions answered to my satisfaction. I hereby consent to this procedure. This constitutes full disclosure and supersedes any previous verbal or written disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleLemonBottle\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleLemonBottle\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"lemonBottleDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script>\n<\/div><fieldset id=\"field_8_115\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_115.1' id='input_8_115_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_115_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_115.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_115.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_46\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_46'>\n\t\t\t<div class='gchoice gchoice_8_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='YES'  id='choice_8_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_46_0' id='label_8_46_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='NO'  id='choice_8_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_46_1' id='label_8_46_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_179\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_179'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_179' id='input_8_179' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_143\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_143'>\n\t\t\t<div class='gchoice gchoice_8_143_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='YES'  id='choice_8_143_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_143_0' id='label_8_143_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_143_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='NO'  id='choice_8_143_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_143_1' id='label_8_143_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_182\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_182'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_182' id='input_8_182' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_142\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_142'>\n\t\t\t<div class='gchoice gchoice_8_142_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='YES'  id='choice_8_142_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_142_0' id='label_8_142_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_142_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='NO'  id='choice_8_142_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_142_1' id='label_8_142_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_181\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_181'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_181' id='input_8_181' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_141\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_141'>\n\t\t\t<div class='gchoice gchoice_8_141_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='YES'  id='choice_8_141_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_141_0' id='label_8_141_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_141_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='NO'  id='choice_8_141_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_141_1' id='label_8_141_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_183\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_183'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_183' id='input_8_183' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_140\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Do you have any skin conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_140'>\n\t\t\t<div class='gchoice gchoice_8_140_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='YES'  id='choice_8_140_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_140_0' id='label_8_140_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_140_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='NO'  id='choice_8_140_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_140_1' id='label_8_140_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_180\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_180'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_180' id='input_8_180' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_139\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_139'>\n\t\t\t<div class='gchoice gchoice_8_139_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='YES'  id='choice_8_139_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_139_0' id='label_8_139_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_139_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='NO'  id='choice_8_139_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_139_1' id='label_8_139_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_184\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_184'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_184' id='input_8_184' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_138\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_138'>\n\t\t\t<div class='gchoice gchoice_8_138_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='YES'  id='choice_8_138_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_138_0' id='label_8_138_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_138_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='NO'  id='choice_8_138_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_138_1' id='label_8_138_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_185\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_185'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_185' id='input_8_185' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_137\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_137'>\n\t\t\t<div class='gchoice gchoice_8_137_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='YES'  id='choice_8_137_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_137_0' id='label_8_137_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_137_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='NO'  id='choice_8_137_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_137_1' id='label_8_137_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_187\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_187'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_187' id='input_8_187' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_136\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_136'>\n\t\t\t<div class='gchoice gchoice_8_136_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='YES'  id='choice_8_136_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_136_0' id='label_8_136_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_136_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='NO'  id='choice_8_136_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_136_1' id='label_8_136_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_186\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_186'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_186' id='input_8_186' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_135\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Is there any other Medical and\/or Social History that we should know? If so, please provide full detail here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_135'>\n\t\t\t<div class='gchoice gchoice_8_135_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='YES'  id='choice_8_135_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_135_0' id='label_8_135_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_135_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='NO'  id='choice_8_135_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_135_1' id='label_8_135_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_188\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_188'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_188' id='input_8_188' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_134\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_134'>\n\t\t\t<div class='gchoice gchoice_8_134_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_134' type='radio' value='YES'  id='choice_8_134_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_134_0' id='label_8_134_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_134_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_134' type='radio' value='NO'  id='choice_8_134_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_134_1' id='label_8_134_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_189\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_189'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_189' id='input_8_189' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_81\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_81'>\n                            \n                            <span id='input_8_81_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_81.3' id='input_8_81_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_81_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_81_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_81.6' id='input_8_81_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_81_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_75\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_75'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_75' id='input_8_75_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_75_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_75' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_75_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_75_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_75_data' name='input_8_75_data' value=''><\/div><\/div><fieldset id=\"field_8_76\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_76.1' id='input_8_76_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_76_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_76.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_76.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_221\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Filler Dissolving<\/h3><\/div><div id=\"field_8_190\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"fillerDissolvingDisclaimer\" class=\"disclaimer-container\">\n<p><strong>Client Disclaimer for Filler Dissolving Treatment<\/strong><br><br>\n\n<b>Product Information:<\/b><br>\nFiller dissolving is an aesthetic medical procedure that uses Hyaluronidase, an enzyme designed to break down hyaluronic acid-based dermal fillers. This treatment is used to correct overfilled areas, asymmetry, migration of filler, or unwanted results from previous dermal filler treatments.<br><br>\n\n<b>Treatment Information:<\/b><br>\nThe procedure involves injecting Hyaluronidase into the area where dermal filler is present. The enzyme works by dissolving the hyaluronic acid filler over time. Results may be immediate or gradual, and in some cases, more than one session may be required depending on the amount and type of filler present. This is a non-surgical procedure performed by a qualified practitioner.<br><br>\n\n<b>Potential Risks:<\/b><br>\nWhile generally considered safe, potential risks include:\n<ul>\n<li>Localised pain, swelling, redness or bruising at the injection site<\/li>\n<li>Allergic or hypersensitivity reaction to Hyaluronidase<\/li>\n<li>Infection if aftercare instructions are not followed<\/li>\n<li>Over-dissolving of filler, which may lead to volume loss<\/li>\n<li>Temporary changes in facial appearance or asymmetry<\/li>\n<li>In rare cases, more serious complications may occur<\/li>\n<\/ul>\n\n<b>Benefits:<\/b><br>\nPotential benefits include correction of undesirable filler results, improved facial symmetry, reduced filler-related complications, and restoration of a more natural appearance.<br><br>\n\nI have been advised of the relevant information associated with this treatment and I confirm I fully understand this advice. This includes:\n<ul>\n<li>The aims\/motivations for having the procedure and the desired outcome<\/li>\n<li>The risks inherent in the procedure<\/li>\n<li>The risks inherent in refusing the procedure<\/li>\n<li>The risks specific to me<\/li>\n<li>The expected benefits of the treatment<\/li>\n<li>The potential disadvantages of the treatment<\/li>\n<li>Alternative procedures and their pros and cons \u2013 including the option of no treatment at all<\/li>\n<li>Any uncertainties about and the likelihood of success of the procedure<\/li>\n<li>Any follow-up treatment that may be required<\/li>\n<\/ul>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b><br>\nI agree to and authorise the taking of clinical photographs and videos. I understand that these will form part of and will be kept with my confidential medical records.<br><br>\n\nI certify that I have read the above consent, fully understand it, and have had all my questions answered to my satisfaction. I hereby consent to this procedure. This constitutes full disclosure and supersedes any previous verbal or written disclosures.\n<\/p>\n<\/div>\n\n<span id=\"toggleFillerDissolving\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleFillerDissolving\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"fillerDissolvingDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script><\/div><fieldset id=\"field_8_191\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_191.1' id='input_8_191_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_191_1' >I have read the above information and agree to it<\/label><input type='hidden' name='input_191.2' value='I have read the above information and agree to it' class='gform_hidden' \/><input type='hidden' name='input_191.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_8_192\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_192'>\n\t\t\t<div class='gchoice gchoice_8_192_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_192' type='radio' value='YES'  id='choice_8_192_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_192_0' id='label_8_192_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_192_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_192' type='radio' value='NO'  id='choice_8_192_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_192_1' id='label_8_192_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_206\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_206'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_206' id='input_8_206' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_193\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_193'>\n\t\t\t<div class='gchoice gchoice_8_193_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_193' type='radio' value='YES'  id='choice_8_193_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_193_0' id='label_8_193_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_193_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_193' type='radio' value='NO'  id='choice_8_193_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_193_1' id='label_8_193_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_207\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_207'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_207' id='input_8_207' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_209\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_209'>\n\t\t\t<div class='gchoice gchoice_8_209_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_209' type='radio' value='YES'  id='choice_8_209_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_209_0' id='label_8_209_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_209_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_209' type='radio' value='NO'  id='choice_8_209_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_209_1' id='label_8_209_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_211\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_211'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_211' id='input_8_211' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_195\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_195'>\n\t\t\t<div class='gchoice gchoice_8_195_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_195' type='radio' value='YES'  id='choice_8_195_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_195_0' id='label_8_195_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_195_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_195' type='radio' value='NO'  id='choice_8_195_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_195_1' id='label_8_195_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_219\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_219'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_219' id='input_8_219' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_196\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Do you have any skin conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_196'>\n\t\t\t<div class='gchoice gchoice_8_196_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_196' type='radio' value='YES'  id='choice_8_196_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_196_0' id='label_8_196_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_196_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_196' type='radio' value='NO'  id='choice_8_196_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_196_1' id='label_8_196_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_220\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_220'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_220' id='input_8_220' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_197\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_197'>\n\t\t\t<div class='gchoice gchoice_8_197_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_197' type='radio' value='YES'  id='choice_8_197_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_197_0' id='label_8_197_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_197_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_197' type='radio' value='NO'  id='choice_8_197_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_197_1' id='label_8_197_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_218\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_218'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_218' id='input_8_218' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_198\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_198'>\n\t\t\t<div class='gchoice gchoice_8_198_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_198' type='radio' value='YES'  id='choice_8_198_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_198_0' id='label_8_198_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_198_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_198' type='radio' value='NO'  id='choice_8_198_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_198_1' id='label_8_198_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_216\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_216'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_216' id='input_8_216' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_199\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_199'>\n\t\t\t<div class='gchoice gchoice_8_199_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_199' type='radio' value='YES'  id='choice_8_199_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_199_0' id='label_8_199_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_199_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_199' type='radio' value='NO'  id='choice_8_199_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_199_1' id='label_8_199_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_217\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_217'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_217' id='input_8_217' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_200\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_200'>\n\t\t\t<div class='gchoice gchoice_8_200_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_200' type='radio' value='YES'  id='choice_8_200_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_200_0' id='label_8_200_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_200_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_200' type='radio' value='NO'  id='choice_8_200_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_200_1' id='label_8_200_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_215\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_215'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_215' id='input_8_215' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_201\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Is there any other Medical and\/or Social History that we should know? If so, please provide full detail here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_201'>\n\t\t\t<div class='gchoice gchoice_8_201_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_201' type='radio' value='YES'  id='choice_8_201_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_201_0' id='label_8_201_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_201_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_201' type='radio' value='NO'  id='choice_8_201_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_201_1' id='label_8_201_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_214\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_214'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_214' id='input_8_214' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_202\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_202'>\n\t\t\t<div class='gchoice gchoice_8_202_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_202' type='radio' value='YES'  id='choice_8_202_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_202_0' id='label_8_202_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_202_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_202' type='radio' value='NO'  id='choice_8_202_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_202_1' id='label_8_202_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_212\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_212'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_212' id='input_8_212' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_203\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_203'>\n                            \n                            <span id='input_8_203_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_203.3' id='input_8_203_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_203_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_203_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_203.6' id='input_8_203_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_203_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_204\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_204'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_204' id='input_8_204_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_204_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_204' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_204_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_204_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_8_204_data' name='input_8_204_data' value=''><\/div><\/div><fieldset id=\"field_8_205\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_205.1' id='input_8_205_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_205_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_205.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_205.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_256\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PDO Thread Lift<\/h3><\/div><div id=\"field_8_223\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n.disclaimer-container {\n  max-height: 120px; \n  overflow: hidden;\n  transition: max-height 0.5s ease;\n}\n\n.show-toggle {\n  color: #0066cc;\n  cursor: pointer;\n  font-weight: 600;\n  margin-top: 8px;\n  display: inline-block;\n}\n<\/style>\n\n<div id=\"threadLiftDisclaimer\" class=\"disclaimer-container\">\n<p><strong>PATIENT CONSENT<\/strong><br><br>\n\nThis is an informed consent form that has been prepared to help inform you of the potential benefits and risks of thread lift procedures. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.<br><br>\n\nIt is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.<br><br>\n\nThread lifts are a minimally invasive alternative to a facelift using naturally resorbable suture materials. Two commonly used thread materials include PDO and PLLA.<br><br>\n\n<b>1. PDO Threads:<\/b><br>\nPDO threads are made of Polydioxanone (PDO). They have a dual effect: immediate tightening\/lifting of the skin and stimulation of collagen production over 3\u20136 months. PDO threads are 100% resorbable and degrade into carbon dioxide and water. Types include mono, cog, and screw threads. Mono threads provide a gentle lift, cog threads provide stronger lifting due to barbs, and screw threads provide volume.<br><br>\n\n<b>2. PLLA Threads:<\/b><br>\nPLLA threads (e.g. Silhouette Soft) are composed of Poly-L-Lactic Acid. They last up to 12 months and stimulate longer-term collagen production. They dissolve into glucose, carbon dioxide, and water over time.<br><br>\n\nThread lifts are used on areas such as the midface, cheeks, eyebrows, nose, neck, and jawline. PDO threads provide stronger immediate lift, while PLLA threads are better for volumisation. Results evolve over 6 months and may last up to 2 years. Top-up treatments may be required.<br><br>\n\nThe procedure involves marking insertion points, applying local anaesthetic, and inserting threads using a needle or blunt cannula. No surgical incisions are required. Multiple threads may be used depending on the desired result.<br><br>\n\nI understand that results vary between clients and are not guaranteed. More than one treatment session may be required to achieve or maintain results. I understand I will be informed in advance of each session and can change my mind at any stage.<br><br>\n\nThread lifts are not a replacement for surgical facelift procedures.<br><br>\n\n<b>RISKS AND SIDE EFFECTS:<\/b><br>\nCommon risks include temporary pain, swelling, bruising, bleeding, puckering, dimpling, and lumpiness. These usually resolve within 1\u20132 weeks.<br><br>\n\nUncommon risks include infection, prolonged dimpling, thread migration, asymmetry, poor cosmetic outcome, or prolonged discomfort.<br><br>\n\nRare risks include allergic reactions, granuloma formation, tissue necrosis, nerve injury, permanent scarring, or facial weakness\/paralysis.<br><br>\n\nI confirm I fully understand the following:\n<ul>\n<li>Aims and expected outcome of the procedure<\/li>\n<li>Risks of the procedure<\/li>\n<li>Risks of refusing treatment<\/li>\n<li>Personal risks specific to me<\/li>\n<li>Benefits and limitations of treatment<\/li>\n<li>Alternative options including no treatment<\/li>\n<li>Uncertainties and likelihood of success<\/li>\n<li>Possible follow-up treatments<\/li>\n<\/ul>\n\n<b>CLINICAL PHOTOS AND VIDEOS:<\/b><br>\nI consent to clinical photographs and videos being taken and stored in my confidential medical records.<br><br>\n\nI confirm I have had sufficient opportunity to discuss the procedure, ask questions, and make an informed decision. I consent to the treatment and understand this replaces any previous information given.\n<\/p>\n<\/div>\n\n<span id=\"toggleThreadLift\" class=\"show-toggle\">Show More<\/span>\n\n<script>\ndocument.getElementById(\"toggleThreadLift\").addEventListener(\"click\", function () {\n  var box = document.getElementById(\"threadLiftDisclaimer\");\n  \n  if (box.style.maxHeight && box.style.maxHeight !== \"120px\") {\n    box.style.maxHeight = \"120px\";\n    this.textContent = \"Show More\";\n  } else {\n    box.style.maxHeight = box.scrollHeight + \"px\";\n    this.textContent = \"Show Less\";\n  }\n});\n<\/script><\/div><fieldset id=\"field_8_224\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Do you understand the information you have been provided?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_224'>\n\t\t\t<div class='gchoice gchoice_8_224_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_224' type='radio' value='YES'  id='choice_8_224_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_224_0' id='label_8_224_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_224_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_224' type='radio' value='NO'  id='choice_8_224_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_224_1' id='label_8_224_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_237\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_237'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_237' id='input_8_237' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_238\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. Do you feel sufficient information has been provided to you, to enable you to consent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_238'>\n\t\t\t<div class='gchoice gchoice_8_238_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_238' type='radio' value='YES'  id='choice_8_238_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_238_0' id='label_8_238_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_238_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_238' type='radio' value='NO'  id='choice_8_238_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_238_1' id='label_8_238_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_239\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_239'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_239' id='input_8_239' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_226\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Has your consent been freely given?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_226'>\n\t\t\t<div class='gchoice gchoice_8_226_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_226' type='radio' value='YES'  id='choice_8_226_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_226_0' id='label_8_226_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_226_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_226' type='radio' value='NO'  id='choice_8_226_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_226_1' id='label_8_226_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_241\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_241'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_241' id='input_8_241' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_227\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Do you have any medical conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_227'>\n\t\t\t<div class='gchoice gchoice_8_227_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_227' type='radio' value='YES'  id='choice_8_227_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_227_0' id='label_8_227_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_227_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_227' type='radio' value='NO'  id='choice_8_227_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_227_1' id='label_8_227_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_240\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_240'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_240' id='input_8_240' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_236\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. Are you pregnant or breastfeeding?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_236'>\n\t\t\t<div class='gchoice gchoice_8_236_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_236' type='radio' value='YES'  id='choice_8_236_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_236_0' id='label_8_236_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_236_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_236' type='radio' value='NO'  id='choice_8_236_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_236_1' id='label_8_236_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_242\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_242'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_242' id='input_8_242' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_234\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_234'>\n\t\t\t<div class='gchoice gchoice_8_234_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_234' type='radio' value='YES'  id='choice_8_234_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_234_0' id='label_8_234_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_234_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_234' type='radio' value='NO'  id='choice_8_234_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_234_1' id='label_8_234_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_243\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_243'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_243' id='input_8_243' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_233\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7. Do you have an autoimmune disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_233'>\n\t\t\t<div class='gchoice gchoice_8_233_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_233' type='radio' value='YES'  id='choice_8_233_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_233_0' id='label_8_233_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_233_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_233' type='radio' value='NO'  id='choice_8_233_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_233_1' id='label_8_233_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_244\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_244'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_244' id='input_8_244' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_232\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >8. Do you have any known allergies or have ever had anaphylaxis?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_232'>\n\t\t\t<div class='gchoice gchoice_8_232_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_232' type='radio' value='YES'  id='choice_8_232_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_232_0' id='label_8_232_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_232_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_232' type='radio' value='NO'  id='choice_8_232_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_232_1' id='label_8_232_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_245\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_245'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_245' id='input_8_245' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_231\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >9. Do you have any active infection at the intended site of procedure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_231'>\n\t\t\t<div class='gchoice gchoice_8_231_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_231' type='radio' value='YES'  id='choice_8_231_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_231_0' id='label_8_231_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_231_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_231' type='radio' value='NO'  id='choice_8_231_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_231_1' id='label_8_231_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_246\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_246'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_246' id='input_8_246' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_230\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Are you taking antibiotics or other prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_230'>\n\t\t\t<div class='gchoice gchoice_8_230_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='YES'  id='choice_8_230_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_230_0' id='label_8_230_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_230_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='NO'  id='choice_8_230_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_230_1' id='label_8_230_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_247\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_247'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_247' id='input_8_247' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_229\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >11. Is there any other Medical and\/or Social History that we should know?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_229'>\n\t\t\t<div class='gchoice gchoice_8_229_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='YES'  id='choice_8_229_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_229_0' id='label_8_229_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_229_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='NO'  id='choice_8_229_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_229_1' id='label_8_229_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_248\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_248'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_248' id='input_8_248' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_228\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >12.Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_228'>\n\t\t\t<div class='gchoice gchoice_8_228_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_228' type='radio' value='YES'  id='choice_8_228_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_228_0' id='label_8_228_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_228_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_228' type='radio' value='NO'  id='choice_8_228_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_228_1' id='label_8_228_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_250\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_250'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_250' id='input_8_250' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_249\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >13. Do you have any concerns?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_249'>\n\t\t\t<div class='gchoice gchoice_8_249_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_249' type='radio' value='YES'  id='choice_8_249_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_249_0' id='label_8_249_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_249_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_249' type='radio' value='NO'  id='choice_8_249_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_249_1' id='label_8_249_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_225\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_225'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_225' id='input_8_225' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_251\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >14. Is there anything else we should know?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_251'>\n\t\t\t<div class='gchoice gchoice_8_251_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_251' type='radio' value='YES'  id='choice_8_251_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_251_0' id='label_8_251_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_251_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_251' type='radio' value='NO'  id='choice_8_251_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_251_1' id='label_8_251_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_255\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_255'>Please fill in your answer if answered YES to the above<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_255' id='input_8_255' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_254\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >15. Eleganza Aesthetics will retain this information throughout the course of my treatment and refer to it as required - Are you happy with this ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_254'>\n\t\t\t<div class='gchoice gchoice_8_254_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_254' type='radio' value='YES'  id='choice_8_254_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_254_0' id='label_8_254_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_254_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_254' type='radio' value='NO'  id='choice_8_254_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_254_1' id='label_8_254_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_257\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_257'>\n                            \n                            <span id='input_8_257_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_257.3' id='input_8_257_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_257_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_257_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_257.6' id='input_8_257_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_257_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_258\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_258'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_258' id='input_8_258_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_258_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_8_258' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/eleganzaaesthetics.co.uk\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_8_258_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_8_258_resetbutton' 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