• Intimate Lightening

    CLIENT INTAKE & MEDICAL HISTORY
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • What are your area(s) of concern for treatment?*
  • Are you currently taking any blood thinning medication?*
  • Are you currently?*

  • Medical History

    Please check all that apply
  • Have you ever had an allergic reaction to any of the following?*
  • Check the conditions that apply*

  • Consent and Liability Wavier

    Initial each section.

  • Intimate Lightening is a cosmetic procedure used to treat hyperpigmentation concerns in intimate areas. The process involves cleansing, microdermabrasion, intimate peel, lightening serum and moisturizer. This treatment can be done every 7 days until the desired results are achieved. Thereafter, routine maintenance is recommended. 

    Please read and initial the following statements:

  • Due to nature of this treatment, we take photos for progress tracking and marketing purposes. Your identity is kept confidential if you consent. Do you agree to be photographed or videotaped before, during, and after treatment? We shall own the photos and recordings.*
  • Should be Empty: