New Client Consultation Form

  • New Client Consultation Form

  • Date*
     - -
  • Gender

  •  -
  • How did you hear about the Secret Garden Spa?*

  • Your Skin

  • How would you describe your skin?*

  • When was the last time you went tanning, were sunburnt, or used a tanning bed?*

  • What are your skin care challenges?*

  • Please tell me what skincare brands you are using and how often do you use them?

  • Do you/have you used glycolic acid, lactic acid, mandelic acid, salicylic acid, hydroquinone, Retinol, Retin-A, Renova, Differen/Adapalene, Accutane (Isotretinoin), Tretinoin (Retinoic Acid), or other Vitamin A derivitives?*
  • Have you received any of these hair removal services in the last 30 days?*

  • Have you ever had any of these skincare treatments in the past?*

  • Your Health

  • Have you experienced any of these health conditions in the past or present?*

  • Do you?*
  • Any known allergies?*

  • Have you used or been prescribed any medications (topical or oral) for acne / acne control?*
  • Are you a smoker? *
  • Have you ever experienced claustrophobia? *
  • Please rate your stress level*
  • Are you using hormonal birth control?*

  • Are you pregnant or trying to become pregnant?*

  • Are you undergoing any hormone replacement therapy?
  • Should be Empty: