• Are you currently being treated by your GP or medical specialist?

  • Do you currently use any medication on a regular base?

  • Do you currently use anti-clotting drugs?

  • Do you have any known allergies or are you sensitive to certain materials, drugs or anesthetics?

  • Are you (possibly) pregnant?

  • Do you experience neurological diseases or complaints or are you currently being treated by a neurologist?

  • Do you suffer from an infectious or auto-immune disease?

  • Do you suffer from a skin disease or do you experience any skin complaints?

  • Did you ever had a treatment to improve skin conditions like dermabrasion, laser treatment, IPL treatment or a chemical peeling?

  • Do you suffer from pigment disorders?

  • Are you suffering from increased sensitivity for light?

  • Do you suffer from a Herpes infection (e.g. cold sore)?

  • Do you suffer from any muscular disease?

  • Do you suffer from hartdisease, vascular or circulation problems?

  • Do you experience frequent nose bleeding, bruising or suffer from coagulation disorders?

  • Do you suffer or ever sufferd from a reduced ability to swallow?

  • Does a relative suffers from a hereditary muscular disease (e.g. congenital muscle weakness, Myasthenia Gravis, etc.)?

  • Did you recently have surgery of the face?

  • Are you currently being treated by an ophthalmologist or have you ever been treated by one?

  • Are you suffering from an eye condition or do you experience any vision problems?

  • Do you (frequently) experience dryness of the eyes?

  • Did you have surgery of the eyes or eyelids in the past?

  • Do you smoke? If so, how many cigarettes a day?

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