Returning Client Intake Form

  • Returning Client Intake Form

  • Please complete the information below to update Cherish Beauty Aesthetics of any recent changes to your health. This will allow us to effectively and safely treat your skin.

  • Date
     / /

  • Contact Information

  • Date of Birth*
     - -

  • Skin and Medical Health

  • Do you currently have a cold sore, sunburn/windburn, hair removal/waxing or eczema flare on your face?*
  • In the last two weeks, have you received any of the following procedures?*
  • In the last 2 weeks, have you used any exfoliating products such as AHAs, Salicylic Acid, Benzoyl Peroxide, or Retinoids (Tretinoin, Differin, Retinols, Retinaldehyde, etc?) If yes please specify below.*
  • Have there been any changes to your health, allergies, or medications since your last visit? If yes, please specify below.*
  • Are you currently pregnant or breastfeeding?*

  • Skin Goals & Routine

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  • Lifestyle Considerations

  • Have there been any lifestyle changes that may negatively impact your skin? Such as sudden increase in stress or prolonged stress, poor diet/water intake, lack of sleep, environmental exposures, etc.

  • Preferences

  • Would you like a silent appointment? (limit speaking/conversation to only what's necessary for your treatment)?

  • Failure to Disclose

    It is your responsibility to provide Cherish Beauty Aesthetics with all your relevant medical details and health history prior to each treatment. We will not be liable for any damage that occurs because of your failure to disclose such details.
  • I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received.*

  • Terms & Conditions

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