SKINCARE CONSULTATION
Guest Name
Date
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Month
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Day
Year
Date
What is your skin type? Select all that apply
Dry Oily
Normal
Combination Sensitive
What are your skin care concerns and/ or what would you like to prevent? Select all that apply
Aging
Hyperpigmentation
Sensitivity
Redness / Rosacea
Acne / Breakouts
When was your last facial treatment?
What is your skincare routine at home?
Pre-Cleanse
Cleanse
Tone
Exfoliate
Masque
Essence
Serum / Concentrate / Oils
Moisturize
Eye Care
Lip Care
SPF Protection
Body Care
Do you prefer a foamy, milky or oil cleanser?
Foamy
Milky
Oil Cleanser
Do you prefer a physical exfoliant, chemical exfoliant, or both?
Physical
Chemical
Both
Do you prefer a gentle (no spice) exfoliant or active (spicy/warm) exfoliant?
Gentle
Active
SKINCARE CONSENT
Do you have any allergies?
Have you had Botox in the last two weeks?
Yes
No
Please list any medications, skin care supplement or any treatments you hae had that could make your skin more sensitive/ reactive: (ie: Retin-A, AccuTane, chemical peel, laser hair removal, etc)
Signature
Date
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Month
-
Day
Year
Date
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