LTB Facial Consultation

Free LTB Facial Consultation
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
How did you hear about LTB?
How did you hear about us?

InstagramFacebookGoogleFriend/ReferralWalk-inOther
Skin Concerns
What are your main facial concerns? (You can choose more than one)

Acne/BreakoutsBlackheads/CongestionOily skinDry/Dehydrated skinRedness/SensitivityFinelines/WrinklesUneven skin tone/PigmentationDull skinLarge poresScarringOther
Have you had any facial treatment before?

YesNo
If yes, which ones and when
Are you currently using any skincare product?

YesNo
If yes, please list them or bring them to your appointment
Do you have any allergies or skin conditions? (e.g. eczema, rosacea, dermatitis)

YesNo
If yes, please explain
Are you currently taking any medication (topical or oral)?

YesNo
If yes, please specify
Goals and expectations:
What are your skincare goals? (e.g. glowing skin, clearer complexion, anti.aging)
Are you preparing for a special event?

YesNo
If yes, when?

MonthDayYear
Date
How would you describe your skin type?

OilyDryCombinationNormalSensitiveNot sure
Our services at LTB:
Which services are you interested in learning more about?

Deep Cleansing FacialAcne Treatment FacialAnti-Aging FacialHydratation BoostLED Light TherapyDermaplaningMicrodermabrasionSkin NeedlingLymphatic DrainageOther
Would you like us to recommend a treatment plan tailored to your skin needs?

YesNo
Consent and signature

I confirm that the information provided is accurate and complete. I understand that results may vary depending on skin type, health, and compliance with after care.
Please note: after submitting your details, you must select an available time and your preferred beauty therapist through our booking system.
Or, feel free to message us at +61 405 659 417 to help you find the best time that suits you. Thank you!
Client Signature
Date

MonthDayYear
Date
Should be Empty:

Free LTB Facial Consultation