Topical anaesthetic

Numbing cream client questionnaire & evaluation.

Please read carefully before completing this form
01

Complete the questionnaire below and press submit.

02

Click through to the payment portal using one of the product links below.

A cart empty notification may appear - this is normal, no need to worry.

03

Complete payment through our online store to finalise your order.

Select your product

Pre-numb Cream & Stay-numb Gel 10g Order
Stay-numb Gel 10g only Order
Pre-numb Cream 10g only Order

Delivery & clinic notes

If you require both the Pre-numb and Stay-numb products, please check with your therapist first. There is an additional $12 postage charge if you need your product sent to your chosen clinic (preferred) or home address.

We will call you if there is anything on your questionnaire we need to discuss. Once we receive your completed form, we will post your order to your allocated clinic (preferred) or your home address - or you can arrange for your therapist to collect on your behalf.

Please ensure you fill out the name of the clinic where you are booked in for your procedure.

Client questionnaire

Complete the form below to begin your evaluation.