Turtle Lily Spa
15340 Dallas Parkway Suite 2220, Dallas, Texas 75248
Email: Turtlelilyspa@gmail.com
IG: TurtleLilySpa
(469) 579-9980
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Referral
Internet
Instagram
Other
Are you on any medication?
*
Yes
No
If Yes, Can you specify what type medication? If none, type “N/A”.
*
What would you like to achieve from your treatment?
*
Back
Next
Have you ever had a chemical peel, laser treatments, microabrasion?
*
Yes
No
If yes, please specify which one and when.
*
Hacer you ever had a facial treatment before?
*
Yes
No
If Yes, please specify when and what type of facial treatment, you’ve recently gotten done
*
Do you use Retin-A, Renova, Adaplaene Hydroxyl Acid, or Retinol/Vitamin A Dervative Products?
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Yes
No
If yes, please specify which one and when was the last time you’ve used it.
*
Have you used any hair removal methods in the past 6 weeks? (Check all that Apply)
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No
Waxing
Laser
Plucking
Threading
What areas of concern do you have regarding your skin? (Check all that Apply)
*
Breakout/Acne
Sun Damage
Rosacea
Dehydration
Dry Skin
Dark Circles
Uneven Skin Tone
Excessive Oil/Shine
Redness
Wrinkles
Puffiness
Dullness
Have you ever had an allergic reaction to any of the following? (Check all that apply)
*
None
Medication
Cosmetics
Animals
Latex
AHAs
Iodine
Food
Shellfish
Dairy
Essential Oils
Do you use SPF?
*
Yes, Daily
Yes, Once and a while
Yes, but I forget
No
What SPF do you use? If none, type “NA”
*
Have you had any recent tanning bed or sun exposure that changed the color of your skin recently?
Yes
No
If yes, how recently? If not, type “NA”
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