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Book your complimentary initial consultation 03 548 8216

Cosmetic, Medical & Vein Clinic

How We Help
Cosmedical Treatments
Varicose Veins
About Us
News
Contact Us

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Injectable Cosmetic Treatments
Non-Injectable Cosmetic Treatments
Varicose Veins
Products

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How We Help
Cosmedical Treatments
Varicose Veins
About Us
News
Contact Us

Complimentary Consultations!

We offer no-obligation Varicose Vein Assessments with Ultrasound Mapping
OR
Initial Cosmedical Consultations
These can be at our Nelson clinic, or the Churchill Private Hospital in Blenheim.

Injectable Cosmetic Treatments
Non-Injectable Cosmetic Treatments
Varicose Veins
Products

Client Form

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New Client Form

1Your Details

2Medical History

3Further Info

4Can We Help Further?

Name
Prefix First Last
DATE OF BIRTH
DD slash MM slash YYYY
Next of Kin - In Case Emergency
Next of Kin Contact No
Your MOBILE #
HOME #
WORK #
EMAIL
OCCUPATION
Would you like appointment reminders by:
- email
- TXT
- Phone call
Address
Street Address Suburb City Post Code

Do you smoke?
- YES
- NO
- Ex-Smoker
Stopped
ETHNICITY
Gender
- Male
- Female
Are you pregnant
- YES
- NO
Do you take contraceptives/ Hormones
- YES
- NO
Current & Past Illnesses/Operations?
Current Medications?
Over the counter products?
Known Allergies?
GP / DOCTORS NAME
@CLINIC
Have you had any problems with Surgery and/or Local Anaesthetics
- YES
- NO
Please explain
Do you suffer from any of the following;
- Asthma
- Diabetes
- Heart Condition
- Bleeding diseases
- Transmittable viral Infections (Cold sores/hepatitis for example)

HOW DID YOU HEAR ABOUT US?
- YELLOW PAGES
- RADIO
- NEWSPAPER
- MAGAZINE
- THERAPIST
- INTERNET - WEBSITE
- FRIEND
- WALK BY
- OTHER
Their name
First Last
Please elaborate

WOULD YOU LIKE INFORMATION ON ANY OF THE FOLLOWING
- Varicose Vein removal
- Cosmetic Injectables
- Fine lines/ Skin resurfacing
- Lipodissolve/Body Contouring
- Sun damage &/ or Pigmentation
Would you like to receive promotional material and /or newsletter and emails from us from time to time?
- YES
- NO
Cosmedical & Varicose Vein Assessment Consultations are currently COMPLIMENTARY
A Consultation Fee is charged by Dr Orsbourn of $70.00 /Varicose Vein Assessment with scan usually $140.00
Once you submit this form you will be forwarded to a confirmation page. Additionally, a copy of this form will be sent to your email address, whilst the original will be forwarded directly to our Clinic.
Comments
This field is for validation purposes and should be left unchanged.

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In-Clinic Complimentary Consultations

We offer no-obligation Varicose Vein Assessments with Ultrasound Mapping
OR
Initial Cosmedical Consultations
These can be at our Nelson clinic, or the Churchill Private Hospital in Blenheim.

CONTACT US HERE
Or call 03 548 8216

Or Book a Virtual Consultation

Additionally, we offer, complimentary, no-obligation ‘Virtual Consultations’ for both Varicose Vein and Cosmetic Treatments. A great option if you live some distance from our clinic.

BOOK YOURS HERE

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Useful Links

DermNet NZ: The Dermatology Resource.
Botox: For manufacturer's information on Botox uses etc.
NZ Society of Cosmetic Medicine.
Australasian College of Aesthetic Medicine.
Advanced Skin Technology.
Profhilo.
RegenLab PRP.
New Zealand Society of Procedural Phlebology.

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Contact Us

enhanceskin
03 548 8216

7 Buxton Square
Nelson

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Download and read our Autumn Newsletter HERE.

Latest News

Pregnancy and varicose veins. We can help Nelson and Marlborough based new mums

Pregnancy and varicose veins

As a specialist varicose vein doctor in Nelson and Marlborough, people often ask David about …

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Search our Website

Search this website

Injectable Cosmetic Treatments
Non-Injectable Cosmetic Treatments
Varicose Veins
Products

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_{BOTOX® is a Prescription Medicine containing 100 units of botulinum toxin type A for injection. It is used for the treatment ofn frown lines, forehead lines and crow’s feet, And for the treatment of severe primary hyperhidrosis of the axillae. It should be administered only by trained medical professionals. Talk to your specialist about the benefits/risks of this procedure.

Cautions: People with defective neuro-muscular transmission disorders, infection at site of injection, glaucoma, pregnancy and lactation. Possible side effects include headaches, injection site pain/burning/stinging/bruising/swelling/redness, local muscle weakness including drooping eyelids/eyebrows, eyelid swelling, skin tightness, tingling sensations, aching/itching forehead, nausea and flu-like symptoms. For hyperhidrosis it can include perceived increase in sweating in areas other than the underarms, pain at the injection site, pain, hot flushes and transient arm weakness. If you have any side effects or concerns speak to your doctor. You will need to pay for this medicine. Normal Doctors visit fees apply.

Note: BOTOX® facial treatment lasts about four months and after this time further courses of treatment may be necessary. BOTOX® hyperhidrosis treatment lasts about 7.5 months and after this time further courses of treatment may be necessary Speak to your specialist about your own situation.

BOTOX® is a registered trademark of Allergan, Inc. Allergan Australia Pty Ltd. ABN 85 000 612 831, 77 Ridge Street, Gordon, NSW 2072. Allergan New Zealand Ltd, PO Box 1873 Auckland 1000, New Zealand.}

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