Existing Client Intake Form

Existing Client Intake Form

Please only submit this form if you have already filled out a New Client Intake Form.
Name

First NameLast Name
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I am an existing client
Would you like to have a quiet session for this treatment?
Have you started any new medications or supplements since your last treatment?
If your answer is no, please type no in the text box.
Have you purchased or started using any new skincare or haircare products since your last treatment? If yes, please write the names of the products in the text box.
If your answer is no, please type no in the text box.
I have not received any facial injectables, filler/botox, laser hair removal or other laser treatments in the area being treated in the last 14 days.
I have not received any facial waxing, threading, or other hair removal within the last 72 hours.
I have discontinued the use of any products containing retinoids and other exfoliating products for 2-3 days before this treatment.
All of my health conditions are the same as when I filled out my intake form, including pregnancy. If something has changed, we will discuss it in the treatment room.
I have no viruses such as active cold sores, warts, bacterial infections or fungal infections.
I agree that I am not currently feeling sick or just getting over being sick. I agree that I have no contagious sickness, infection, or disease that can affect the well being of my esthetician or any other client with The Skin Cafe.
I agree that my treatment or any home care products must be paid in full by using cash, card, Apple/Phone Pay, or a gift card purchased through the website- and by paying cash I will save 3.5% of my total purchase.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: