Hi! What's your name?
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First Name
Last Name
Do you have any medical conditions or health concerns that could potentially be an issue?
Would you like to receive personal product recommendations?
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Do you have any cosmetic allergies or known sensitivities?
Is there anything important going on in your life right now that might be important to disclose before your facial? Ie. Stressful periods or events, grief, loss, insomnia, divorce etc are all things that can wreak havoc on your body . Please share anything you wish here or in person before we start if you feel like it’s appropriate.
Have you ever had a facial before?
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What did you like or dislike most?
Do you have any cosmetic allergies or known sensitivities?
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Yes
No
If yes, please describe:
How would you describe your skin type/concerns?
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Balanced, “normal”
Dry or dehydrated
Acneic/hormonal
Mature
Pigment issues
Rosacea/hyperreactive, compromised barrier
Please elaborate further, if it’s relevant:
What are your skin goals, for this facial and in the future?
What products or routine are you using now? Please list any active ingredients like AHAs, BHAs, retinol/vitaminA, any procedures done recently:
Preferences
Are you okay with doing some extractions(removing blackheads etc)
Yes
No
Other
If you have many extractions, which ones would you like to address most?
Near the end of the facial, a scalp massage is done which can leave your hair messy.
Please go ahead with scalp massage
Please skip the scalp massage
Other
Do you have a preference for a type of music you would like to be played?
Add-Ons
My Products
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Cocoa Enzyme Mask
$
10.00
CAD
This mask is suitable for all skin types including rosacea and reactive. Uses enzymes to exfoliate, and cocoa antioxidant, reveals brighter, plumper more glowing skin.
Zymase Enzyme Mask
$
10.00
CAD
This mask is more active than the cocoa. Should only be used after cocoa has first been used, with no adverse reaction unless your skin is: Damaged/Aged/Heavily keratinized/Glycated This powerful enzyme contains multiple forms of vitamin c designed to brighten, tighten and exfoliate the skin.
Warm Oil Scalp/Hair Treatment
$
10.00
CAD
Warmed MCT oil is a dandruff safe oil that helps scalp skin and follicle health. Helps to hydrate, repair, and strengthen hair, while also soothing dry and itchy scalps
Total
$
0.00
CAD
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