Skincare Form (facials/dermaplaning)

Skincare Form (facials/dermaplaning)

To be used to analyze and treat your skin for facials and or dermaplaning services
NAME

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Have you ever been under the treatment of a dermatologist, plastic surgeon or aesthetician?
treated by DR
Please advise what treatments or procedures if answer above is yes
What are your skin concerns

Sun Spots/ Brown spotsRednessFirming/WrinklesAcneVellus HairOther
Please list any medications you are taking

Are you pregnant l
Please list any allergies to medications

*
Do you get cold sores *

Waxing, microdermabrasion, dermaplaning or chemical peels will make your skin sensitive to the sun and will require sunscreen every 90 minutes or as instructed on your sunscreen bottle - Please type "YES" that you understand this.*
Certain medications such as Accutane, Retinol, Aspirin, prescription or over the counter medications can interfere with waxing and/or skin services. Please advise your skin technician of any OTC products or prescription medications you are taking or state "NONE"
By signing this form, you are authorizing Serendipity Salt & Skin Spa / DBA Serendipity Massage & Skin Spa, to analyze and treat your skin concerns. *If anything changes in your allergies, medications, health or OTC products please advise your skin technician. You are releasing Serendipity from any liabilities.
Signature*

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