• GemSpa Client Consultation Form

  •  - -
  • Your Skin Care

  • What skin care products are you currently using?

    List brands if known
  • Cleanser
    Toner    
    Day Moisturizer      
    Night Moisturizer      
    Exfoliator      
    Mask      
    Eye Product      
    SPF/Sunscreen      
    Scrubs      
    Makeup Products      
    Soap      
    Shower Gels      
    Body Lotions    
    Other      

  • Lifestyle

  • Female clients

  • Male Clients

  • Future Appointments/Contact

  • I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that is supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contradications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or the technician/esthetician/skin care professional from liability and assume full responsibility thereof. 

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