• Confidential Hyaluron 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 Hyaluron Treatment!  If you are a longtime Spa Aeon skincare client but are new to Hyaluron, 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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  • 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 and/or in rare circumstances, medical complications from the treatments received. I am aware that it is my responsibility to inform the Hyaluron Technician 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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