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  • 2) Have you ever had a body spa treatment before? Massage: Salt glow: Seaweed wrap:

  • 3) Which of the following best describes your skin type? (Please circle one type number)

  • IV V VI

  • Creamy complexion Light Complexion Light/Matte Complexion Matte Complexion Brown Complexion Black Complexion

  • Associated Skin Care Professionals

  • Client Consultation - continued

  • 10) Have you recently used any self-tanning lotions, creams or treatments?NoYes, specify:

  • 12) What areas of concern do you have regarding your: Skin: (Please check any that apply and explain)

  • Sun spot/liver spot/brown spot

  • Other: dehydratedcracked/chapped lips 13) Have you ever had an allergic reaction to any of the following? (Please check any that apply and explain) If yes, please explain:

  • Associated Skin Care Professionals

  • Client Consultation- - continued

  • May | contact you via mail/email about future promotions and news?

    I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previ- ous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments | receive here are voluntary and | release this institution and/or skin care profes- sional from liability and assume full responsibility thereof.

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