BAE IT UP

  • NEW CLIENT INTAKE FORM

  • Appointment Date*
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  • Date of Birth*
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  • Gender*
  • Format: (000) 000-0000.
  • How did you know about us?*

  • FOR FEMALE CLIENTS:

  • Are you pregnant or trying to get pregnant?*
  • Are you taking oral birth control pills?*
  • Are you breastfeeding?*

  • HEALTH HISTORY

  • Have you experienced any of these health conditions in the past or present?*
  • Do you smoke?*
  • Do you wear contact lenses?*
  • Have you ever had an allergic reaction to any of the following? (Check all that applies)*

  • SKIN CARE HISTORY

  • What skin care products do you currently use? (check all that applies)*
  • Have you received any Botox or Filler injections in the last 14 days?*
  • How often do you consume water daily?*
  • How often do you consume caffeinated beverages daily?*
  • Please select your skin type:*
  • Please check if you have any of the following skin conditions: (check all that applies)*
  • Which of the following best describes your skin type?*

  • CLIENT CONSENT FORM

  • I hereby grant BAE IT UP my permission to take photos/videos of my treatment to be used for social media purposes.*

  • By signing below, I certify that I have read and fully understood the contents of this consent form, and that the information I provided above are complete, accurate, and up-to-date to my knowledge.

  • Date*
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  • Should be Empty: