New Client Intake Form

  • New Client Facial Intake Form

    This form is intended for new clients, and it is crucial to provide honest and accurate answers. Please disclose any conditions or history that may pose a risk for reactions to any received services.
  • Date of Birth*
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  • Skin History

  • What are your specific concerns / challenges with your skin?*
  • Have you ever had a facial or skin treatment before? *
  • During the facial treatment do you prefer to be quiet or to chat*
  • What skin type do you think you have?*
  • How does your skin heal?*
  • Exposure of the sun?*
  • Does your skin bruised easily?*
  • Do you have a tendency to redness?*
  • Have you ever used acne medication?*
  • Do you ever experience these conditions on your skin?*
  • What skin care products are you currently using on your face? Please check all that apply.*
  • 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 facial services in the last 14 days? *
  • If yes, please confirm last date
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  • Your Medical History

    Do you have or have you had any of following conditions? If yes, please check all that apply:
  • Please check that applies to you currently or in the past:*

  • Any known allergies? (aspirin, nuts, fruits, shellfish, essential oils etc)*

  • Any recent surgery?*
  • Do you take any dietary / health supplements? If yes, please list

  • Have you currently taken any prescription / over the counter medications*

  • Lifestyle

  • How many cups of caffeine do you drink daily?*
  • Have you ever experienced claustrophobia?*
  • Do you exercise frequently?*
  • Do you sleep well?*
  • Do you smoke?*
  • Do you follow a restricted diet?*
  • Do you?*
  • Please rate your stress level*
  • Do you manage stress well?*

  • Females Clients

  • Are you using hormonal contraception (Birth Control)?
  • Are you pregnant or trying to become pregnant?
  • Are you breastfeeding/nursing
  • Do you have regular periods?
  • Any menopause issues?
  • Do you have a diagnosed hormonal imbalance?

  • Acknowledgement and Waiver

    Pre Facial Advice:

    • Please avoid the use of any exfoliants 7 days before your appt.
    • Botox/filler injections must be done 2 weeks before your facial.

    ‼️ Please read your post-facial care instructions carefully ‼️

    Use a gentle cleanser, hydrating serum, and moisturizer to support healing and hydration.

     

    For 1 week, avoid any exfoliating or active ingredients like:
     • AHA/BHA
     • Retinol
     • Vitamin C (in toners, serums, or moisturizers)

     

    If you're using benzoyl peroxide for acne, please pause for 7 days—it’s considered a deep exfoliant.

     


    SPF is a must! Apply it daily to protect your skin from UV damage (Wear Every 2 Hours)

     

    Avoid wearing makeup or heavy skincare for 24 hours after your treatment.

     

    No direct sun exposure or tanning for 48 hours—and never use tanning beds. Wear a hat if you’re going outside!

     

    Refrain from picking or squeezing your skin. Even if you notice minor imperfections or leftover congestion, resist the urge to avoid scarring or irritation

     

    Avoid hot showers, saunas, and intense workouts for 48 hours (if you have reactive or sensitive skin, try to avoid much as possible

     

    Stay hydrated—drink lots of water to help your skin detox and stay plump

     

    Change your pillowcase, towels, and washcloths regularly—ideally daily or at least weekly to prevent bacteria buildup.

     

    We encourage open communication and will do our best to address any concerns you may have throughout your treatment. We want you to understand that we put our clients' safety and well-being first. Please be assured that we are fully committed to maintaining the highest level of care and safety.

  • Do you give Adore Skin Studio permission to post photos/short video clips of you on their social media?*
  • Please follow the recommended homecare instructions after your appointment to ensure the best results.*
  • Should be Empty: