Microdermabrasion Facial Form

Microdermabrasion Facial Form
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Best way to contact you?
How did you hear about us?
If referred, by who?
How would you describe your skin?
Do you have a skin care routine?
What skin products do you use on daily basis?
Any known Allergies?
Have you had the following procedures in 2-4 weeks?

Other
Are you currently under a doctor’s care?
Do you suffer any of the following diseases?

Other
Are you currently taking any of these medications?

Other
When was your last exposure to the sun?

Other
Circle your skin type when exposed to the sun for 1-2 hours without sunscreen.

Other
Are you planning a vacation in the sun soon?
Are you pregnant, lactating, or planning a pregnancy soon?
Anything you would like to add?
I acknowledge, I have read and completed this questionnaire truthfully. I agree and understand that withholding information or providing misinformation may result an irritation to the skin from treatments received. The treatment I receive on my appointment are voluntary, I release Karina's Beauty Spa and all affiliated skin care professionals from liability, I assume full responsibility.
I understand, To cancel an appointment you must cancel BEFORE 24 hours. my booking site will send you emails, scroll to the bottom and hit manage my appointments from there you will be able to cancel your appointment. If it's after the 24 hour mark it's not going to let you and I will charge you a 50% cancellation fee for any cancellation done after 24 hours. Cancellation and “No Show” fees will be charged to the credit card on file. Once this charge is completed, you may then schedule a new appointment. If the card declines, a hold will be put on your profile in our system. ALL FEES must be paid before booking a new appointment. By having a card on file and reading and understanding the policy, you are giving Karina’s Beauty Spa PERMISSION to charge your card in the event of a late, cancellation, and/or a no-show.
Karina’s Beauty Spa has a 10 minute GRACE PERIOD, If you are more than 10 minutes late there's a high possibility of your appointment being canceled. It's not fair for the rest of my clients who are on time. There will be charge of 50% of the service you booked. If you are more than 10 minutes late without no notice it will be considered a no call no show and you will be banned from booking in the future. I don't tolerate no call no shows, I'm very easy to communicate with. (Don’t hesitate to reach out, send me a text at 571-343-9903)
Please no extra guest unless if you are bringing a guest that's also getting a service
I understand NO REFUNDS. All purchases are FINAL SALE
I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.

I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.

I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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