Client Skin Consultation Survey
  • Image field 92

  • Acne Bootcamp Consultation

    Skin By Flynn
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  • Birthdate
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  • Ethnicity*

  • How often do your hobbies bring you outside?*
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  • Have you ever had any allergic reactions to any of the above products or anything you have ever put on your face?*
  • Are you wearing a daily sunscren?*
  • Choose your skin type:*

  • Prescribed, Over the Counter and Recreational Drug/Medications (past and present use):*

  • Check if you are allergic to:*
  • Do you smoke/vape?*
  • Do you dermaplane your face?*
  • Do you use fabric softener or fabric softener sheets in the dryer?*
  • Do you pick at your skin?*
  • Do you work with, or are you around chemicals, tars, oils or inks?*
  • Are you currently under alot of stress? (common triggers: job loss, new job, wedding, death in the family or close friend, graduation, long commute, heavily scheduled)
  • Do you regularly consume:*
  • Have you been diagnosed with digestive issues:*

  • What are your skin care concerns?*

  • What else have you done for your skin?*
  • Medical History Within Last Two Years*

  • Section to be completed for Women only:

  • Are you pregnant or nursing?
  • Are you taking Depo Provera shots?
  • Do you have regular periods?

  • I consent to have my picture/video taken for marketing & social media purposes. If you would like an example, please check out my Instagram @Skinbyflynn*

  • Please tick (/) the answer below.

  • How/where did you find Skin By Flynn?

  • I consent to have my picture/video taken for marketing & social media purposes. If you would like an example, please check out my Instagram @Skinbyflynn*
  • IMORTANT ACKNOWLEDGE ALL*

  • Prior to obtaining the services of Skin By Flynn: Molly Flynn, Licensed Esthetician, I certify that I clearly understand the following: 

    WARNINGS

    Avoid direct sunlight or tanning booths for at least three days following a treatment.

    Use of sunblock protection of at least a SPF 30 is necessary following all treatments.

    Do not pick your skin following a treatment.

     

    I choose to consult with Skin By Flynn as a Licensed Esthetician who conveys skincare information that people can use to enhance skin health. I affirm my right to self-health, and I take full responsibility for my healing process with her guidance and support.

     

    I state that I come to Skin By Flynn, Licensed Esthetician, Molly Flynn with the purest of heart and purpose of seeking information. I state that I do not come with any forethought or will have any afterthought to entrap parties of Skin By Flynn into an illegal statement or action. I understand that Skin By Flynn's sole intention is to offer educational information that will help to bring improvement for my skin.

     

    If I choose to use this information for myself or loved ones, then I affirm that the responsibility is mine. I understand that Skin By Flynn does not provide legal medical services, but instead suggestions that I can choose to use for skin healing. 

     

     

    Please read and sign to acknowledge that you understand and agree to the above statements. You will not be seen without it. 

    Thank you! 

     

  • Guardians

    Please complete if client seeking services is a minor
  • Date*
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  • Should be Empty: