Pre Facial Form
Carly Artistry
Customer Details:
Full Name
*
First Name
Last Name
Phone Number
*
Are you pregnant or breastfeeding?
Yes
No
Have you had elongated sun exposure in the last 2 weeks? If so, please do not book Dermaplaning for 2 weeks.
Yes
No
Have you exfoliated your skin in the last 3 to 5 days? If so, please do not book Dermaplaning for 1 week.
Yes
No
Have you had facial waxing in the last 2 weeks? If so, please do not book Dermaplaning for 2 weeks.
Yes
No
Do you get coldsores?
Yes
No
Have you been on Accutane or Isotretinoin in the last 6-12 months? If so, please do not book Dermaplaning for 6 months.
Yes
No
Have you ever had skin cancer?
Yes
No
Do you have a bleeding disorder?
Yes
No
Have you had any major chemical peels or laser treatments in the last month?If so, please do not book Dermaplaning for a month.
Yes
No
Do you have diabetes?
Yes
No
Are you currently getting chemotherapy or radiation?
Yes
No
Do you only want to use vegan, cruelty free, fragrance free, or gluten free products? Select all that apply.
Vegan
Cruelty Free
Gluten Free
Fragrance Free
I can use anything
How would you describe your skin? Select all that apply.
Oily
Dry
Sensitive
Acne Prone
Combo (Oily & Dry)
Please list any prescription skincare you have used in the last 2 weeks or put "N/A" if not applicable :
Please list any skin conditions you have been diagnosed with by a dermatologist or put "N/A" if not applicable:
Please list ALL allergies you have:
What is your current skincare routine? Morning and night:
What do you want achieve with your skin?:
Submit
Should be Empty: