• Skin Kay Beauty Client Intake Form

  • Date of birth*
     - -
  • Format: (000) 000-0000.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Please take a moment to answer the following questions:

  • Skin Concerns and Goals*
  • Are you pregnant?*
  • Do you use acne medication?*
  • Please check if you are affected by or have any of the following
  • Are you presently taking any medications?*
  • Do you have any allergies to cosmetics, food or drug?*
  • Have you had skin cancer?*
  • Are you taking oral contraceptives?*
  • I confirm that all information provided in this intake form, including any uploaded photos, is accurate and complete to the best of my knowledge. I understand that any incomplete or inaccurate information may limit the quality and relevance of the virtual consultation advice.

    This virtual consultation is strictly educational and informational. It is not a medical service, diagnosis, prescription, or treatment, and should not replace advice from a licensed healthcare professional such as a dermatologist or physician. SkinKayBeauty is a licensed esthetician, not a medical provider, and cannot diagnose skin conditions, prescribe medications, or treat medical issues.

    Any skincare recommendations, product suggestions, routines, or advice given during or after this consultation are general and based solely on the details and photos I provide. I take full responsibility for any decisions I make based on this consultation, including trying new products or routines. I agree to consult a qualified medical professional before making significant changes to my skincare, especially if I have underlying health concerns or experience any irritation/reactions.

    Photo Upload Consent:

    By uploading photos of my skin/face, I consent to sharing them privately with the esthetician solely for the purpose of this virtual consultation to allow for a more accurate visual assessment and personalized advice. I understand and agree that:

    •  These photos will not be shared publicly, posted on social media, websites, or any other platforms.

    •  They will not be linked to my public profile, used for marketing, or shared with third parties beyond what is necessary for secure form storage and consultation review.

    •  Photos are stored confidentially in accordance with privacy best practices and will be deleted upon request or after the consultation period (as applicable).

    •  I have taken the photos myself or have permission to share them, and they accurately represent my current skin condition.

    I agree to notify the esthetician promptly of any changes to my skin condition, routine, or relevant information after submitting this form.

    If I experience any skin irritation, adverse reactions, or concerns while following the provided recommendations, I will seek appropriate medical care immediately and will not hold the esthetician liable for any outcomes.

    I further agree that any inappropriate, illicit, or sexually suggestive behavior, remarks, or advances during the virtual consultation (via video call, messaging, etc.) will result in immediate termination of the session and may prevent future services.

    The services offered are educational only and not a substitute for professional medical care. All information provided is for informational/educational purposes and is not diagnostic or prescriptive.

  • Date*
     / /
  • Payment method*

    prevnext( X )
    USD
  • Payment Methods

    Fastlane Checkout

    Choose from one of the PayPal options to make your payment.

    Contact Info

    Payment Info

  • Should be Empty: