Topical anaesthetic (numbing cream/gel) CLIENT QUESTIONNAIRE & EVALUATION FORM

***PLEASE READ***

Please complete form and push submit.

Sometimes a cart empty notification will pop up, no need to worry about this.  We will email you when we receive the form.

PLEASE GO TO ONLINE STORE TO PAY FOR YOUR ITEM. We will call you if there is anything on your questionnaire we need to discuss.  Once we have received your completed online questionnaire we will post your order out to your allocated clinic (preferred) or to your home address. Alternatively, you may arrange with 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. 

Thank you !