Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Client Consultation Form – Ear Piercing College Name: Client Name: College Number: Address: Student Name: Student Number: Profession: Date: Tel. No: Day Eve PERSONAL DETAILS Age group: Under 20 20–30 Lifestyle: Active Sedentary Last visit to the doctor: 30–40 40–50 GP Address: Have your ears been pierced previously? No 50–60 Yes CONTRAINDICATIONS (select if/where appropriate): Fever Any form of infectious disease Under the influence of recreational drugs or alcohol Diarrhoea and vomiting Cuts and abrasions to the ear/lobe Bruises to the ear/lobe Inflammation to the ear/ lobe Moles on the ear/lobe Warts on the ear/lobe Scar tissue (2 years for major operation and 6 months for a small scar) Severe skin conditions 60+ If yes how long ago: Diabetes Keloid scar tissue Ear infection Cardio-vascular conditions Dysfunction of the nervous system Nervous/Psychotic conditions Allergies to metals Epilepsy Bells Palsy Inflamed nerve of the face, head or ear Recent operations on the face, head, neck or ear Recent injury to the ear/lobe Treatment Details: Client Feedback: Aftercare and Homecare advice: Photographic Evidence: Student/Therapist Signature……………………………… Client Signature……………………………………………... Parent/Guardian Signature (if under 16 years of age)……………………………………………. Version 2