Returning Client Form
Welcome
Thank you for choosing Forsythia Skin Care Studio for your selfcare 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!
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What appointment(s) are you scheduled for?
Luxury Facial
HydraFacial
Oxygen Facial
Signature Facial
Brow Wax and/or Tint
Facial Waxing
Lash Lift & Tint
Body Waxing
Glo2Facial
Luxury HydraFacial
Luxury Glo2Facial
Firming Peptide Facial
Chemical Peel
Brazilian
I don’t remember
Other
How long has it been since your last appointment?
One week
4-6 weeks
Between 2-6 months
Between 6-12 months
Over a year
Since your last appointment have you received a positive pregnancy test?
Yes
No
Known pregnancy
Since your last appointment have you received any Botox injections in the area that will be treated during your scheduled appointment?
Yes
No
If yes, when?
Since your last appointment have you received any Derma-Filler injections (Restylane, Juvederm etc) in the area that will be treated during your scheduled appointment?
Yes
No
If yes, when?
Since you last appointment have you been under the care of a Dermatologist?
Yes
No
If yes please explain.
Since your last appointment have you been under the care of any physician?
Yes
No
If yes please explain.
Since your last appointment have you been under the care of another Esthetician or Medi Spa for treatments?
Yes
No
If yes, for what and when?
Please check off any services you have received outside of Forsythia Skin Care Studio since your last appointment.
None
Microneedling
Chemical Peel
IPL
Laser Hair Removal
Electrolysis
Dermaplaning
Permanent Makeup (Microblading brows included)
Any type of Cosmetic Surgery
Have you used any Retinol or acid based products in the past 72 hours in the area that will be treated during your scheduled service?
Yes
No
Have you used any prescription topical medication in the area that will be treated during your scheduled service in the past 72 hours?
Yes
No
Have you had any reactions or new allergies since your last appointment?
Yes
No
Are you allergic to…
Shellfish
Aspirin
Sulfur
For male facial clients please remember not to shave the day of your appointment.
I understand
Does not pertain to me.
Lash Lift & Tint Appointments- if you wear contact lenses, please remember not wear your contact lenses and to bring your glasses.
I understand
Does not pertain to me.
For Lash Lift & Tint, do you use any lash growth serums?
Yes
No
Does not pertain to me.
Do you have any open lesions, cold sores, pink eye, burns, scabs, infections, cuts etc in the area that will be treated during your scheduled service?
Yes
No
If yes please explain.
Have you had a fever in the past 72 hours?
Yes
No
We want you to be relaxed, comfortable and more than anything we want to be safe with your health as well as our own and others. Being sick during a facial can cause problems for you, your Esthetician and other clients. Please inform us if you have any of the following so we can determine if we need to reschedule. We also ask that if someone in your household has any symptoms to let us know! Thank you!
Cough
Fever (current or past 72 hours)
Sore Throat
Sinus congestion
Sinus infection
Ear infection
Stye or any other eye issue
Rash
Lice
Chicken Pox or Shingles
Tooth ache or infection or recent oral procedure
Cold sore or Fever Blister
Cut or lesion or bruise to the area that being worked on
Flu Symptoms
Cold symptoms
Sunburn, windburn or any type of burn to the area worked on
Cancer
GI issues (stomach issues)
Is there anything in particular you would like your Esthetician to be aware of or focus on during your treatment? (Breakout, redness, texture etc)
Always feel free to note if you need or would prefer a “silent” service! Just type silent below if you are requesting a silent service.
Is there any particular needs or wants you have for your service? Table heater on/off, extra blanket, particular music, extra pillow for under your knees, extra water, etc?
Are there any retail products you need us to put aside for you? Or are there any products you would like more information on?
Please type your name below if you agree that everything answered above is truthful and to the best of your knowledge.
Thank you!
We look forward to seeing you again! Thank you for taking the time to help your Esthetician prepare and be aware to ensure we give you the best treatment every time! To us at Forsythia Skin Care Studio our clients are our friends and family and we want to provide the most spectacular service that you deserve!
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