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Facial Treatment Intake Form

Please complete the following questions to expedite your services and allow for us to prepare for your visit! 

A little about you...

Birthday
Month
Day
Year

Now tell us about your Skin Care Goals...

Skin Goals

What is your Skin Type?

Skin Type (check all that apply)
Do you spend a lot of time outdoors?
Yes
No
About half/half
Other
Do you wax anywhere on your face? Lip, brows, chin, etc
Do you use Sunscreen?

A little history about your skin...

Have you had any of the following treatments? (select all that apply)
Are you currently using any of the following?

Now we have a few questions about your health information...

Have you ever reacted to any of the following?
Do you have/experience any of the following? (check all that apply)

Can discuss this in person - mostly any prescription acne medications or anything that may be contraindicative to the products used during your services.

Last section, we promise!

Photo/Social Media Release
Yes
No
Other

On occasion, we do like to feature treatments on real-life clients, we are respectful of your decision either way and will only feature specified areas for detailed examples on promotional materials, social media, website, or print.

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