• SKIN CONSULT

    ANALYSIS PROVIDED BY A CERTIFIED SKINCARE SPECIALISTS
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  • ABOUT YOU

    MEDICAL HISTORY
  • My skin feels:

  • My skin concerns:

  • I currently use the following products:

  • I'm also using:
  • ANYTHING ELSE WE SHOULD KNOW?

    MORE INFORMATION ALLOWS OUR SPECIALISTS TO FORM A MORE DETAILED ANALYSIS.
  • Are you taking birth control pills or hormone replacement?
  • Are you currently pregnant?
  • I'm going through menopause or HRT:
  • I've had allergic reactions to:

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  • DISCLAIMER

    I understand that the services offered are not a substitute for medical care, and any information provided by the therapist is for educational purpose only and not a diagnostic or prescriptive in nature. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I give consent for all future treatments.
    I acknowledge that the esthetician holds the right to terminate the session at any time.
    I understand that withholding information or providing misinformation may result in contraindications and/or irritation from treatments received.
    I understand that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.
    I release the esthetician from any and all liability associated with any injuries/current and future conditions resulting from the skincare procedures or products used and assume full responsibility thereof. I agree to pay a non refundable $30 security deposit that will be taken off my total or rolled to my next appointment via Venmo or another source of payment. 

    I HAVE COMPLETED THIS SURVEY ACCURATELY AND COMPLETE. I fully understand and agree to the above policies. 

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