Comprehensive Client Intake Form Logo
  • Skin and Health Questionnaire

    Please answer the following questions thoroughly and completely, as this provides a better understanding of your general health, lifestyle, and skin care concerns, thereby enabling the best skin care program to be customized for your individual needs.
  • Skincare History

  • Morning

    Please list your morning skincare routine.
  • Evening

    Please list your morning skincare routine.
  • General Health

  • If yes, please discuss contraindications of any pre-existing medical conditions with your physician.

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  • Female Clients

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  • Photo Release Form

  • Esthetic Therapy typically takes before-and-after pictures to demonstrate the results accomplished by using products or receiving services. Photos are stored in your profile for office use and to track your progress. If the photos are exceptional, we may want to feature them on our website, social media, and/or marketing materials.

    We want your permission to use images taken of you to showcase before and after results on our website, social media, and/or marketing materials.

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