Form

Name

First NameLast Name

What’s your Instagram

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of schedule appointment

Date

Please type what service you are booking:

How do you hear about Iris Esthetics?

Tell me about your skin. What are your main skin concerns? What skin goals are you looking to achieve?

For woman: are you currently pregnant or trying to get pregnant?

For Men: are you currently shaving your face ?

How would you describe your skin?

What is your current skin regiment?

Have you had a facial treatment in the past ?

Please select if you have had any of the following:

If so, how recently?

List any allergies ?

If no allergies please, type N/A

Are you claustrophobic?

Do you have any active sores/blisters

What medications/hormone replacement/vitamins do you presently take?

Have you ever used or currently on any the following?

I consent for Iris Esthetics to take my before and after photos/videos taken and posted on various social media platforms for means of advertising and marketing.

I blanks do fully understand all the questions above and have answered them all correctly and honestly. I understand that the services offered are not a substitute for medical care. I understand that the skin care professional will completely inform me of what to expect in the course of treatment and will recommend adjustments to my regimen if deemed necessary. I also am aware that individual results are dependent upon my age, skin condition, and lifestyle. I agree to actively participate in following appointment schedules and home care procedures to the best of my ability, so that I may obtain maximum effectiveness. In the event that I may have additional questions or concerns regarding my treatment or suggested home product routine, I will inform my skin care professional immediately. I release and hold harmless the skin care professional Iridian,(Iris Esthetics) from any liability for adverse reactions that may result from this treatment.

POLICY

•If necessary, please reach out 24 hours before scheduled appointment time if you need to reschedule. Less than 24 hours notice will result in loss of your non-refundable deposit. Non-refundable deposits can be applied to rescheduled appointment if done so in advance. Under any circumstances, no show/no call’s will no longer be able to book any future appointments, as well as their forfeit deposit.

If you are not satisfied with your service or products, please contact your skin care professional within 24-hours after your appointment so that the situation may be corrected. It is our policy to provide you with the best professional service and products customized for your skin condition.

*I have read and understood all of the foregoing information.

Signature

Facial Health Questionnaire