Client Intake Form

Client Intake Form

This form must be completed prior to your appointment to ensure safe and personalized service
Pre-treatment notice

Clients are advised to discontinue the use of active skincare ingredients (such as retinol, AHAs, BHAs, and exfoliating treatments) at least 5–7 days prior to their appointment to prevent over-exfoliation and skin sensitivity.
Name

First NameLast Name
Date of Birth

MonthDayYear
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Service Selection
(Select all services you are booking for).

Other
Health & Skin History
Do you have any allergies or sensitivities?
If yes, please list
Are you currently taking any medications?
If yes, please list
Are you pregnant or breastfeeding?
Do you have any of the following conditions?
How would you describe your skin type?
Do you experience:
If yes, please state.
Do you ever experience burning, itching or stinging sensations on your skin?
Lash & Brow Services

(If receiving lash or brow services)
Do you have sensitive eyes?
Have you ever had any reactions to lash glue or tint before?
Do you have any of the following in the brow area?
Have you had brow tint or brow lamination before?
If yes, did you experience any reaction or irritation?
If yes, please explain.
Skin & Waxing Services

(If receiving facials, waxing, or vajacials)
Have you had any of the following in the last 7 days?
Are you currently using Retinol, Accutane, or any prescription skin treatment
What are your main skin or beauty goals?
I confirm I have discontinued active skincare products as advised prior to my appointment
I confirm that I am at least 18 years old or have parental/guardian consent to receive services
I have read and completed this questionnaire truthfully. I understand that withholding information or providing inaccurate details about my medical history, allergies, medications, and skincare routines may lead to contraindications or adverse reactions to the treatments I undergo. I agree to inform the aesthetician of any changes in the above information.
Date

MonthDayYear
Date
Should be Empty:

Client Intake Form

Pre-treatment notice

Service Selection

Health & Skin History

Lash & Brow Services

Skin & Waxing Services