Lavish Looks New client form

New Client Information

Information for Lavish Looks
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
What is your age?*
MaleFemale
What is your Main concern with your skin?*
What skin care products are You using? pleaSe expLain skin care Routine honestly!*
Please list allergies and medications (iNCluding blood pressure medication and chemo medication).*
Do you have any metal in your body*
Have you ever had a facial, if so when was your last?
Have you ever been waxed, if so when was the last time?
Are you Using any skin thinneRs or doing chemotherapy?
Have you been prescribed acne medication, if so when was the last time you used it?
AcneAllergiesBloatingCancerConstipationDiabetesDiarrheaFatigueFrequent HeadachesHigh Blood PressureHigh CholesterolOverweight / ObesePeriMenopause / Menopause symptomsPMS / Menstrual IrregularitiesStrokeThyroid diseaseWeight lossOther
List all supplements, herbs, vitamins you are taking. Also, Indicate why you are taking them. If you have not been taking any, type NONE*
Are you pregnant?*
How often do you exercise? How long have you been doing this?*
What is a typical Diet for you?*
How many hours of sleep do you get each night? Do you feel rested?*
How many cigarettes and / or cigars do you smoke each day or week?*
Have you been diagnosed woth COVID-19 or around anyone who HaS?*
Signing this form means you understand that lavish LOoks is not responsible for any reaction the Body has to products used, burning of the skin, skin lifting, hair damaGe and eyes burning. After care is always explained after each service it is critical that you follow the after care instructions. Lavish looks is not liable for anything after the appointment is complete. Please make sure everything on this form is Correct. *
Yes
Yes
Signature*
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New Client Information