• Skincare Consultation Form

  • Date*
     - -
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • How did you hear about us?

  • Your Skin

  • What are your skincare challenges?
  • Have you ever had a facial or skin treatment before?*
  • What skincare products do you currently use?*
  • Do you use Retin-A, Renova, Adapalene, Accutane, Differin, Glycolic Acid, Lactic Acid, Mandelic Acid, Retinol, or other Vitamin A derivatives?
  • Have you received any of these hair removal services in the last 30 days?
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments?
  • Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?

  • Your Health

  • Have you ever experienced claustrophobia?
  • Please rate your stress level
  • Have you experienced any of these health conditions in the past or present?*
  • Do you?*
  • Any known allergies?*
  • Have you used or been prescribed any medication for acne?*

  • Female Clients

  • Are you taking birth control?
  • Are you pregnant or trying to become pregnant?

  • Male Clients

  • What is your current shaving system?
  • Do you experience irritation from shaving?
  • Should be Empty: