New Client Registration Form (FOR FACIALS ONLY)

Client Consultation Form

Facial
Full Name*

First NameLast name or initial
Phone Number*

Area CodePhone Number
E-mail (optional but best for email alerts)
How did you hear about us?*
Other
Have you had a Facial Before?*

yesno
if yes, when?
Do you have any special skin problems or concerns pertaining to your face or body? *
Do you use Retin-A, Renova, AHA, or Retinol derivative products?*
if yes please specifyas to what . Has it been used in the past 3 months?
Have you had any chemical peels, microdermabrasion, or laser? if yes when?
Using any acne medication? if so what one?
What type of skincare products are you currently using? (cleansers? toners? SPF? exfoliator, serums, etc) Tell me as much as you can.
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Client Consultation Form