Application for CAP Therapy

Thank you for your interest in CAP therapy. 

To help us match you with available appointment slots, please complete the form with as much detail as possible. More availability increases the likelihood of an earlier start.

After you submit the form, we will contact you to book your information session when a slot becomes available for you. Please add admin@skinsolaceclinic.co.uk to your safe senders list and check your junk inbox.

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Email *
What is your full name? *
What is the best number to contact you on? 
(including country code)
 *
Where are you located? City/Country *
What is your skin concern? *
Are you using a pacemaker? We cannot treat anyone with an electrical device in their body. *
When would you like to start treatment? *
The treatment requires a commitment of travelling down to our clinic in Winchester, UK, weekly for a minimum of 6 months. Is this achievable? *
How long have you suffered from TSW for? *
Please provide your steroid/protopic usage history in detail. Please tell us the duration of steroid usage, potency and affected areas in GRAMS. Please contact your doctor for a full prescription history.  *
We require certain medications to have been stopped for a minimum of 8 weeks with the support of your doctor before starting CAP treatment.

Have you been on any of the following medications within the past two months?
 *
Required
Please provide in detail your current care regime: how often you take baths/showers, products used on your skin including moisturisers, make up, shower/bath products, hair products etc.  *
Do you have any other medical conditions we should know about? *
Required
Are you on any other medication for other medical conditions? If yes, please list them below and the reasons why you are taking them: *
Are you pregnant? Note that we cannot treat anyone while they are pregnant. *
How did you hear about us?
To estimate your weekly treatment duration; please list all body areas you wish us to focus on. If you are unsure about a particular area, we recommend including it.

The durations next to each body part are average timings for each area.
 *
Required
Our price list is below, with pricing based on average treatment times. 
This should help you estimate your weekly treatment cost.

Online information session* via Google Meets:
30 mins - £30
*Required before starting treatment

CAP Treatment - Pay as you go rate:
1 hour - £180

CAP Credits
Please refer to our website for the latest discounts: https://www.skinsolaceclinic.co.uk/treatment-prices
Please read the following Terms & Conditions and tick each box to acknowledge them: *
Required
A copy of your responses will be emailed to the address you provided.
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