Oshun Cosmetic Services

Intake Form


So we can prepare for your visit and keep you safe, please take a few minutes to complete your confidential health intake. Your answers go straight to your care team and are kept private, in line with the Jamaica Data Protection Act 2020.

Welcome back — are these still correct?

We’ve filled in what you told us before so you don’t have to type it again.

✓ Thanks — your details are confirmed. You can still change them below.

I.

About you


II.

Address & next of kin


Next of kin — who should we call if we can’t reach you?

Ideally a different number from yours.

III.

Biological sex


This determines which assessment questions apply to you. Hormonal symptom screens differ by biological sex.

V.

Anything else


Reviewed by Dr. Charles Rockhead. Confidential.

✓

Thank you

Your assessment has been received. Dr. Rockhead will review it before your visit. If anything stands out we'll reach out by WhatsApp or email.