Online Consultation | New You Medical Aesthetics

ONLINE CONSULTATION
with Dr Ndlela
personalised skin and aesthetics guidance from the comfort of your home R600-30minutes

First name

Last name

Contact Number

Preferred Consultation Method

Zoom

Watsapp Video

Medical History: Are you currently taking any medication?

Are you currently taking any medication?

Do you have any illness or Chronic diseases?

Do you have any allergies ( Food, medicaton, skin care products)

What are your main skin or aesthetics concerns?

Have you had any previous aesthetic treatments? If yes, which ones and when?

What is your current Skincare Routine? Which products are you using?

I understand that this consultation is for education and advisory purposes only and does not consitute an in-person medical procedure

NB: PLEASE ENSURE THAT YOU BRING YOUR CURRENT SKINCARE PRODUCTS AND THAT YOUR ENVIRONMENT IS QUITE AND CLEAR

Payment Instructions

R 600

Banking Details

FNB

NDLELA HEALTHCARE GROUP

63084898841

Once your payment and form is received you will be contacted to confirm your consultation time

CAPITEC

NN NDLELA

1195875671

REFERENCE: NAME + SURNAME

watsapp or email pop or simple upload it below

Proof of payment

CLIENTS DETAILS

MEDICAL AND SKIN HISTORY

YOUR SKIN GOALS

CONSENT & AGREEMENT

PAYMENT & CONFIRMATION