ADS Evaluation Form

  • Allana Davis Studio — Client Intake & Consent

    Thank you for completing this form. It takes about 3 minutes. Share only what feels relevant — this helps me tailor your treatment safely and effectively.
  • Todays Date*
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  • Personal Information

  • Date of Birth
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  • What are you looking to improve?*

  • Skin Care & Active Product Use

    This helps me adjust your treatment safely. If something doesn’t apply, simply select ‘No.'
  • Are you currently using any active skin care products? Examples: retinol, Retin-A, glycolic acid, salicylic acid, benzoyl peroxide.*
  • Have you ever reacted to a Vitamin C product? Reaction may include stinging, redness, inflammation, or breakouts.*

  • Medical & Health History

    This information helps ensure your treatment is safe and appropriate. Please answer to the best of your knowledge.
  • Do you have any allergies to skin care products, medications, shellfish, iodine, or latex?*
  • Have you taken Accutane (Isotretinoin) within the past 6 months?*
  • Do you have any of the following skin conditions?*
  • Do any of the following apply to you?*
  • Do you experience claustrophobia during treatments that cover the eyes or mouth?*
  • Are you currently pregnant or trying to become pregnant?*
  • Are you currently breastfeeding?*
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  • Skin Profile & Sun Exposure

    This section helps guide treatment depth, product selection, and post-care.
  • Do you have difficulty healing or a history of scarring?*
  • How does your skin typically respond to sun exposure?*
  • Have you had significant sun exposure, tanning, or a spray tan in the past 30 days?*
  • Are you sensitive to heat or light during treatments?*
  • Do you currently have milia (small white bumps under the skin)?*

  • Consent & Acknowledgements

    Please review and acknowledge the following so we can proceed with your treatment safely.
  • May we take before/after photos for your client file?*

  • Appointment & Cancellation Policy

    I understand that appointments canceled with less than 24 hours notice, late arrivals, or no-shows may incur the full service fee.

  • Date (Signature Date)*
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  • Should be Empty: