• Confidential Plasma Lift Intake Supplement

  • Welcome!  This intake form is a supplement to the Confidential Skincare Intake Form.  Both forms contain important information for safe consideration of your interest in the Plasma Lift Treatment!  If you are a longtime Spa Aeon skincare client but are new to Plasma Lifting, please fill out a fresh copy of the regular Confidential Skincare Intake Form so we can properly plan for your home skincare use before and after this treatment.

    Here you will find many sensitive but important questions, so please fill it out privately, fully, and at a time when you have all of your skincare products, medications, and supplements at hand, and be sure to keep scrolling until you have answered everything, signed, and clicked Submit.  The health and lifestyle topics addressed herein ALL have the potential for affecting your skin or causing interactions with aspects of your treatment at Spa Aeon...  if they didn't, they would not be included.

    Your Health Intake and Treatment Notes are held in the strictest confidence.  

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  • Topical Retinoids are a category of anti-aging & anti-acne prescription and non-prescription skincare products that use a variety of different molecular forms of Vitamin A to treat the skin.  Retinoids may include: Retin-A, Renova, Tretinoin, Differin, Green Cream, Tazorac, Retinol, Retinyl Propionate, Vitamin A, or Beta Carotene.  Topical Retinoid treatment may make up an important part of your Spa Aeon treatment plan.  It is also important that we know beforehand if you are already using them.



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  • I understand, have read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritations to the skin from the treatments received. I am aware that it is my responsibility to inform the Esthetician of my current medical or health conditions and to update this history. The treatments I receive here are voluntary and I release Spa Aeon, Aeon Aesthetics, LLC, Christine Giustra, and our employees, contractors, and agents from liability and assume full responsibility thereof. I understand that requests to cancel or reschedule appointments are gladly accommodated with 24 hours notice and that short-notice cancellations/reschedule requests (less than 24 hours) and no-shows will be charged.

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