Patient Registration Form

PATIENT CONSULTATION PDF Form

If you choose the PDF option, print and complete the form at home and bring it with you to your appointment. Or scan your completed form and email it to us at info@kamloopsskinsolutions.com before you visit the clinic.

RETURN TO > BEFORE YOUR APPOINTMENT

Please use this simple and secure online form which is signed electronically and sent directly to us immediately upon completion.

We occasionally send out news, invitations and special pricing offers. You can unsubscribe at any time.

Lifestyle

Personal History

I hereby certify that the above information is true and correct as to the best of my knowledge.

Clear Signature

Ready to Learn More?

BOOK A CONSULTATION OR DROP INTO OUR LOCATION