Filler Form | Zaza Beauty

Filler Treatment Questionnaire

Name

Age

Gender

Contact Number

Email

Do you have any known allergies? If yes, please specify:

Have you ever experienced any adverse reactions to filler treatments or cosmetic procedures? If yes, please describe:

Are you currently undergoing any medical treatment or taking any medications? If yes, please list:

Do you have any existing skin conditions (e.g., eczema, psoriasis, dermatitis)? If yes, please specify:

Have you had any recent surgeries or medical procedures? If yes, please provide details:

Have you previously received any filler injections? If yes, please specify the type and areas treated:

Are you currently using any other cosmetic treatments or products on your face? If yes, please specify: