New Guest Skin History Form
How did you hear about me?
What service(s) are you interested in booking?
1 hour Peel
What concerns you most about the overall appearance of your skin? Check all that apply.
Excessive facial hair
Fine lines and wrinkles
Under eye puffiness/Dark circles
Loss of lashes or brows
Are there any other concerns you would like to share with me?
How would you describe your skin?
How would you describe your stress level?
Are you currently under the care of a Dermatologist or Physician for any ongoing health or skin concern(s)? If yes please elaborate.
Do you have any allergies to foods, skin care ingredients or medications? If yes, please list and include your reaction.
Are you currently on any medications topical or oral? If yes please list.
How do you heal from a scratch, cut or acne break out?
Do you have an allergy to latex?
Do you tan in tanning beds or booths?
List your level of activity.
Please check all products you are currently using.
Please list the names of the products you are currently using that you checked above. The more detail the better I can tailor your treatments and home care moving forward.
Please upload three photos of your skin without makeup on. One front facing and one of each side, preferably in natural indirect light. This helps me to ensure we are booking the correct treatment, and it also is a good marker for the beginning of our skin care journey together.
Drag and drop files here
Choose a file
The answers I have provided are true and correct to the best of my knowledge. I give Kristin permission to take photos before each treatment to monitor my progress. Please sign below and click submit. I will respond within 24 hours Tuesday-Friday, I look forward to meeting you soon!
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