NEW CLIENT CONSENT
Mission Skin
Date
*
-
Day
-
Month
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of birth:
*
Your postcode:
How did you find me?
When looking at the mirror, what concerns you the most?
Do you currently experience any of the following?
Excess oil
Blackheads
Breakouts
Wrinkles
Dryness
Flakiness
Redness
Broken Capillaries
Flushing
Sensitivity
Pigmentation
Other
My skincare routine is:
I like to keep it minimal
I use more than 3 skincare products daily
I like to use a couple of products, I'm familiar with most of ingredients
Are you currently taking any medication: Aspirin, Steroids, Antibiotics, Accutane, Retinols?
Are you allergic to anything?
Any past and present health conditions I should be aware of?
Have you got any metal parts in your body?
YES
NO
I understand, that my lifestyle, diet and hormonal imbalances directly affect my skin condition.
*
YES
NO
I understand, that everyone responds differently to each treatment, and I may need a few sessions to achieve my goal. That results may vary from person to person, depending on age, current skin condition and severity of the problem.
*
YES
NO
I understand that by booking, I agree to cancellation policy: less than 48h cancellation or rescheduling will result with cancellation fee of £25 (your deposit). *In cases of unexpected events I might decide to waive a fee on some occasions. Appointments not secured with deposit right after will be removed from the schedule.
*
YES
NO
Signature
*
Continue
Continue
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