• Welcome!

    Thank you for choosing Forsythia Skin Care Studio for your skincare needs. To ensure that we are providing you with the most suitable and best quality service we can, please take a moment to answer these questions. Taking the time to do this prior to your appointment ensures that your Esthetician can give all of their attention to you and your service in a timely manner. Thank you and we look forward to seeing you!

  • Let’s get to know YOU!

    Please enter your information so we can know you and your preferences!
  • Birthday
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  • Format: (000) 000-0000.
  • How did you hear about us?

  • Health Information

    Please enter information as honestly and complete as possible. If there are any contraindications with the chosen service we will let you know!
  • Are you currently pregnant or trying to become pregnant?
  • Are you breastfeeding?
  • In the past 7 days have you received any Botox injections?
  • In the past 6 weeks have you received and filler injections? (Juvederm, Restylane, Radiesse, etc)
  • Do you use any Retinol products at home?
  • In the past 12 months have you been on Accutane (Isotretinoin)?
  • In the past 6 months have you been under the care of a dermatologist?
  • Are you or have you been recently (3 months) under the care of another Esthetician?
  • Do you have any metal in your body? (Dental implants, pins, screws, rods, plates, braces, permanent retainer)
  • Do you have a history or epilepsy or seizures?
  • Have you ever been diagnosed with any type and any stage of cancer?
  • Do you have any allergies to the following? Check all that apply.
  • Please check any you currently are experiencing or have recently experienced unless otherwise noted.
  • Please choose what products you use in the MORNING.
  • Please choose which products you use in the evening.
  • Are you claustrophobic?
  • Have you received facials before?
  • In the past 6 weeks have you received any of the following treatments?
  • How often are you looking to receive facials?
  • Let’s hear YOUR opinion on your skin! Please choose any and all skin types and conditions that you feel fit your skin.

  • Schedule Policy

    As a clients based business we rely on your appointment. Last minute cancellations and no-shows not only impact our staff and our business but it also takes available spots away from other clients. We are human and we do understand that there are situations that are out of our control. With that being said we do save the right to charge a last minute cancellation fee, late fee and a no show fee. Please initial next to each statement below. Thank you!

  • Consent & Liability

    Skincare is not an exact science. Treatments and experiences differ from client to client and many different things can attribute towards the outcome such as an individuals at home regimen, medical history, lifestyle and some things that are unknown to both the client and the Esthetician. Because of these differences between all skin, there is no guarantee of the outcome for each service and/or client. To help us understand you and your skin we ask each client to answer all questions truthfully in the intake for to factor in any contraindications or potential adverse reactions. Facial and all skincare treatments are customized depending on the clients needs, wants and skin types. With that being said, there are the rare instances that a client may have a reaction, sensitivity or complication from a treatment. We ask that you please immediately provide your Esthetician with details and information so we can help you in the best way we can. This is the purpose of this intake questionnaire to ensure a safe yet effective treatment experience for both you and your Licensed Esthetician. There may be things that are out of your and the Estheticians control such as an allergy that you may not have been away of prior to your visit.

  • I,         agree that I have filled out the intake form truthfully and to the fullness of my knowledge. I understand that I am willingly having a professional service performed by a Licensed Esthetician at Forsythia Skin Care Studio. I,         will not hold Forsythia Skin Care Studio or my Esthetician liable for any adverse reactions or side effects that could potentially include but are not limited to allergic reactions of the products being used, swelling of the face or a treated area, redness of the skin, stinging, change in pigmentation as well as in an extreme case, cuts, burns, infection, scars, broken capillaries, crusting of the skin or blistering. I,         also understand that it is my responsibility to follow all given post care instructions to avoid any possible adverse reaction. I also understand that it is my responsibility to contact Forsythia Skin Care Studio within 24 hours if I do experience and adverse reactions. I,         to the maximum extent allowed by law, I agree to waive and release and all claims (present or future), suits or any cause action against Forsythia Skin Care Studio or it’s service providers.

  • Photo/Video Consent & Release

  • Thank You

    Thank you again for choosing Forsythia Skin Care Studio for all of you skincare needs. We appreciate you and the time you have taken to fill out this intake form! We, Estheticians at Forsythia Skin Care Studio are very passionate about our clients, treatments and career. We want to always give you the best of the best. Thank you for helping us do that more efficiently.
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