• New Client Consultation Form

    New Client Consultation Form

    Please Fill this form out with the best of your knowledge
  • Date*
     - -
  • Format: (000) 000-0000.
  • How did you hear about Face Forward skin therapy?*

  • Your Skin

  • What are your skin care challenges?*
  • Have you ever had a facial or skin treatment before?*
  • What Skin Care Products and brands do you currently use?*

  • If you are seeking corrective treatments please detail the SPECIFIC products (BRAND & PRODUCT TYPE/NAME) you are currently using so I can best answer any questions on ingredients and help you meet your skin care goals. 

  • Do you/have you used Retin-A, Renova, Adapalene, Accutane, Differen, Glycolic Acid, Lactic Acid, Mandelic Acid, Retinol, or other Vitamin A derivitives?*
  • Have you received any of these hair removal services in the last 30 days?*
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments? *

  • Your Health

  • Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?*
  • Have you experienced any of these health conditions in the past or present?*
  • Do you?*
  • Do you take any of the following dietary / health supplements?
  • Any known allergies?*
  • Have you used or been prescribed any medications (topical or oral) for acne / acne control?*
  • Are you a smoker? *
  • Do you drink more than 4 caffeinated beverages a day? (tea, coffee, soda, energy drinks)*
  • Have you ever experienced claustrophobia? *
  • Please rate your stress level*

  • FEMALE CLIENTS

  • Are you taking birth control? *
  • Are you pregnant or trying to become pregnant?*
  • Any menopause issues? *
  • Are you undergoing any hormone replacement therapy?

  • MALE CLIENTS

  • What is your current shaving system? *
  • Do you experience irritation from shaving? *
  • *Reservation & Cancellation Policy for all current and future appointments: a valid credit card is required for ALL appointments at scheduling through gloss genius and will he used for any chathes that may occur . Please do not forget to confirm your appointment when you receive your reminder from Gloss Genius. In the event of cancellations received less than 48 hours prior to appointment A NON REFUNDABLE rescheduling fee of $25 will be applied to credit card on file. If client fails payment of no show fee, client will be unable to book or receive service from face forward skin therapy inc. until debt is paid. *Deposits and holds: all deposits made are service specific and vary. There are no refunds on deposits. Deposit must be paid at time of appointment as well as rescheduled if canceled, within 30 days of making deposit. Deposit will be lost if appointment isn't made within 30 days of deposit and client will need to submit a new deposit for that service. Deposits are not transferable and can not be used for any product purchase, other service. *ALL clients participating in No Shows/no call will be charged 100% of original service price using card on file. Classified as: a client who does not notify technician of absence within the appointed time scheduled. Any pre-paid treatments,Acne package or peel series will be charged the original of each treatment and not discounted charge per no call,no show. ( ie: acne treatment =$120, glow-up facial = $135*
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