Client Intake Form

Name
Name
Address
Address
Have you had facials before?
Check the concerns that apply to you:
Check the health issues/skin conditions that apply to you:
Do you have any allergies?
Are you allergic to any ingredients?
Have you recently seen a doctor?
Have you had any recent surgeries, laser procedures, or strong exfoliation treatments?
Check if you have used or are currently using any of the following:
Female: Are you pregnant?
Do you have any metal implants or metal piercings?
Check the facial products that you currently use: