SKYNTROLOGY Skin Consultation Form

  • Skin Consultation Form

    Estimated time of completion: 3 minutes

  • Please take your time answering each question so we can create a treatment tailored just for you ᥫ᭡.

  • Date*
     - -
  • Format: (000) 000-0000.
  • Are your pregnant ?*
  • Do you think you have:*
  • Do you have any current Skin Medical Conditions ?*
  • Do You Have (select all that apply):*
  • Have you’ve had any of the following treatments in the last 6 months ?*
  • Are you taking any photosensitizing medications ?*
  • Are you currently on any medications that may increase sensitivity to light?*
  • Have you experienced any of the following reactions to facial treatments or products*
  • Are you taking any medications (prescription or over-the-counter) that might affect your skin? (Check all that apply):*
  • Sunscreen Use: Do you wear sunscreen daily?*
  • Do you smoke marijuana or cigarettes?*
  • Are you okay with being recorded? (Your Privacy Is our biggest concern)*
  • Are you okay with being posted ? (We post before and after’s on our social media accounts ; Google , TikTok and Instagram)*

  • Progress photos will be taken and kept in your confidential client file to track your results.

  • Please note: Corrective treatments such as Chemical Peels and Microneedling are an investment, with individual sessions starting at $250 and corrective packages ranging from $550–$1,800. Treatment recommendations are made after your first appointment. Payment plans for all packages are available.

    Deposits for skin packages are submitted online. Final payment is due in person upon esthetician approval.

  • Pre-Appointment Details

    (Before Your Facial)

    *Please take your time to read* 


    ➤ Arrive with a clean face—no makeup, skincare products, or sunscreen.


    ➤ Avoid exfoliating, retinol, or other active ingredients for 48 hours prior.


    ➤ Stay hydrated!


    ➤ Wear comfortable clothing—you’ll be lying down and relaxing.


    ➤ Eat a light meal beforehand to avoid feeling faint or uncomfortable.


    ➤ Let me know about any allergies, medications, or recent treatments (like waxing or chemical peels).


    ➤ Perform all lip, chin, and eyebrow waxing at least 72 hours before your appointment.

    ➤ For Men that shave: Please shave 72 hours prior to appointment 

    ➤ Please Avoid using any scrubs, acids, actives or retinol products at least 4-7 days prior

    • Discontinue Retin-A, Tretinoin, glycolic acid, mandelic acid, or azelaic acid 7 days before your appointment.

    • Plan ahead - don't have a invasive facial right before a big event

    • Please arrive on time so we can maximize your service & follow all Pre-Care instructions to maximize results

    • No advanced services are provided at any stage of pregnancy .

    •Laser hair removal must be completed at least 7 days prior.

    • No chemical peels or MicroNeedling or any other advanced treatments from other providers within the last 30 days.

    • Avoid excessive sun exposure, tanning beds, or sunburn for at least 5–7 days prior to your appointment.

    • Do not shave the treatment area the day of your facial; shaving should be done 24–48 hours prior if needed.

    • Please inform your provider of any recent illnesses, cold sores, open lesions, or skin infections before your visit.

    • Avoid alcohol and blood-thinning supplements (such as fish oil, aspirin, or ibuprofen) 24–48 hours before advanced treatments, unless prescribed by a physician.

    • Men should arrive clean-shaven unless otherwise instructed for the service booked.

    • Clients currently using oral or topical antibiotics must disclose this prior to treatment.

    • If you have a history of keloid scarring, hyperpigmentation, or sensitive skin, please note this on your consultation form.

    • Results may vary and mild redness, sensitivity, or peeling may occur following treatment.

    We"ll text you 24 hours before or the day of your appointment for confirmation.

    Please text us when you arrive to let you inside.

    10 minutes is the earliest you can come inside prior to your appointment.

  • I acknowledge I have fully READ and understand your Pre-Appointment Details*

  • Client Wellness Verification

    By acknowledging below, I confirm that I am not currently experiencing any illness, fever, infection, or contagious condition prior to treatment.

  • Cancellation & Reschedule Policy

    We do offer 1 reschedule per appointment within our 72 hour window. After the first reschedule, any additional rescheduling or cancellations will require you to book a new appointment and submit a new deposit . If you cancel or reschedule (more then once) within our 72-hour cancellation window a new deposit will automatically be required to secure a future appointment , No call No shows will be unable to book in the future.

  • Consent & Acknowledgment:

    • I understand that the information provided is truthful and confidential and will be used solely to customize my facial treatment.

    • I acknowledge that individual results may vary and that all recommendations are based on the details provided.

    • I agree to immediately inform my esthetician of any discomfort or adverse reactions during the treatment.

    • I will notify my esthetician of any changes to my skin condition or overall health.

  • After submitting this form you may proceed to Step Two for booking your appointment ᥫ᭡.

    We hope to see you soon !
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