New Appointment Form
Everyone likes to experience their facial differently. These questions will help me gage how you’re feeling about your upcoming appointment. You will fill out a new one everytime you come in, so don’t worry if you’d like to change your answer in the future. Thanks so much!
Name
*
First Name
Last Name
I am okay with my aesthetician taking progress photos/video:
*
Yes
No
I would like to listen to this during my treatment: (album/genre/artist/etc.)
*
I would prefer my aesthetician:
*
Educates/Talks me through the service.
Does not talk during the service.
Quietly tells me what’s next in the service.
I would l like the hydro-jelly mask to:
*
Cover my eyes and lips.
Leave my eyes uncovered.
Leave my lips uncovered.
During my hydro-jelly mask, I would like to listen to:
*
Guided Meditation
Music
Spa music
Other
My skin goals for this treatment are:
*
I’m interested in learning more about:
*
Dermaplaning
Eyelash extensions
Nanoneedling
“No-Tox”
LED Light Therapy
Oxygen infusion
Other
Remind me to pick up this product while I’m there:
*
Has anything changed from your previous visits?:
*
All information on my intake form is up to date. I have not gotten filler/botox in the past 14 days. I have no sunburns or sun exposure without SPF. I have no viruses such as colds, flu, fever, cold sores, warts, bacterial infections such as impetigo, boils, conjunctivitis, styes, or fungal infections such as ringworm, blepharitis.
*
I agree.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: