Facial Consultation Form

Facial Consultation Form

*Must be completed after booking (For New and Existing Clients)
I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I might have about obtaining skin services from CYNDO.ESTHETICS hereafter called Cynthia and that all of my questions have been answered to my full and total satisfaction.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Referred By:
How did you find me? (Instagram, TikTok, Word of Mouth, Friends, Family, etc.)*

Studio Policy
The following statements are CYNDO.ESTHETICS policies and I agree to the following rules and regulation:

• I understand that no guests are allowed in the studio. Guests will be asked to leave.

• I understand I should come in with a clean face with no face or eye makeup, oils, or moisturizers.

• I understand it is recommended to shower or wash my hair before service for optimal results. I understand I do not need to wash my face until the day after treatment to allow the products to absorb into my skin.

• I understand it is recommended to wear a strapless bra/top. A towel wrap will be provided as a cover-up. I understand my esthetician will be working on my face, neck, shoulders, and decollete area.

• I understand that pricing is subject to change and that there are no refunds. No exceptions.
I Agree to the Studio Policy
Deposit and Payment
Must be 18+ to book an appointment

Facials: $30 deposit
All deposits are NON REFUNDABLE. A deposit must be sent immediately after booking. Appointment will be cancelled if no deposit is sent. Deposits will go towards your remaining balance.

Payment Options:

Venmo: @cyndo99 (emojis only, nothing service related)
Zelle/Apple Pay: (626) 476-1284
Cash is acceptable for the remaining balance
I Agree to the Deposit and Payment Terms
Late/Rescheduling/Cancellation Policy
Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the esthetician's day that could have been filled by another client. As such, we require a 24-hour notice for any cancellations or changes to your appointment. You may reschedule your appointment ONCE with the same deposit. Clients that provide less than a 24-hour notice or miss their appointment will have their deposit forfeited. Please send a courtesy message if you're running late. If you're more than 15 minutes late, your appointment will be automatically canceled and your deposit will be forfeited. No-shows will not be tolerated and will be banned from booking future appointments.
I Agree to the Late/Rescheduling/Cancellation Policy
YesNo
What would you like to achieve from your treatment today?*
1 - White skin. Always burns, never tans.

2 - Fair skin. Always burns, tans with difficulty.

3 - Average skin color. Sometimes mild burn, tan about average.

4 - Light-brown skin. Rarely burns. Tans easily.

5 - Brown skin. Never burns. Tans very easily.

6 - Black skin. Heavily pigmented. Never burns, tans very easily.
Which of the following best describes your skin type? (1-6)*
YesNo
Chemical peelsLaser proceduresDermabrasionMicrodermabrasionDermaplaningMicro needlingBotoxFillersPMU work (lip blush, powder brows, tattoos)NoneOther
If yes, please indicate how many weeks since service was done
Yes, I will schedule accordingly.
NormalOilyDryAcne ProneCombinationDehydrated
FastPigmentsScarsSlowOther
Retin-ARenovaAHAs/BHAsRetinol/Vitamin A derivativeHydroquinoneAccutanePrescribed topicalsNoneOther
YesNo
YesNo
Please specify the skincare routine you are currently using. If you do not have a skincare routine, please leave it blank.
Cleanser:
Toner:
Day Moisturizer:
Night Moisturizer:
Exfoliator:
SPF:
Serum:
Other:
Once a week2-3x a weekEverydayNever
Uneven skin toneBreakouts/acneSun damageBlackheads/whiteheadsWrinkles/fine linesExcessive oil/shineDull/dry skinRosaceaFlaky skinBroken capillariesDehydrated skinRedness/ruddinessMelasmaAge ManagementHyperpigmentation/scarringLarge poresKeratosis PilarisOther
AHAsIodineEssential OilsFragranceNickelLatexShellfishNutsAnimalsDairySunscreensPollenNoneOther
How often do you use SPF?*
YesNo
YesNoYes, but only using specifically for acne
YesNo
If yes, please specify:
YesNo
Wet shaveDry shave
YesNo
I understand that I must follow AFTERCARE given by my esthetician for optimal results and to prevent/avoid adverse reactions. Redness is normal after treatment and will subside after 24 hours. I must avoid all actives: AHAs/BHAs, exfoliants, retinoids (5-6 days), vigorous exercise & swimming pools (24 hours), saunas/steam (5 days), and direct sun exposure as much as possible. I should avoid applying heavy makeup/skincare products for at least 6 hours. I must also apply gentle products and SPF daily to prevent sensitivity and to maintain my results.*

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

First NameLast Name
Signature*
Date*

MonthDayYear
Date
Anything else I need to know?
Should be Empty:

Facial Consultation Form

Studio Policy

Deposit and Payment

Late/Rescheduling/Cancellation Policy