APPLICATION FORM

Please fill out the following form to help us understand your physical condition and to determine if you are a candidate for the FREE Clinic.

Have you had surgery in the last 6 months?
Have you been referred by your surgeon or oncologist

As spaces are very limited for the FREE clinic, we will assess your application form and let you know if there is a slot available.

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Please note all appointments require a £50 deposit, for the FREE clinic this can either be:

  • Paid Forward to another person

  • Donated to the clinic for stock, consumables, insurance and time

  • Refunded after your appointment

What happens next...

THE CLINIC

Kally Permanent Cosmetics

First Floor 28 Bridge Street

Hitchin

Hertfordshire

SG5 2DF

www.kally.co.uk

Tel: 01462 453888

CONTACT