Client Intake FormPlease Fill Out! Name * First Name Last Name Email * Phone * (###) ### #### Do you have any known allergies, particularly to skincare ingredients? * What is your main skin concerns? examples; aging, discoloration, acne etc * Have you had professional facials before? (If yes, when was your last treatment/facial?) * Please list any current medications you are taking * Do you use any products with active ingredients? (e.g., retinoids, AHA/BHA, vitamin C etc) * Are you currently using sunscreen daily? (Yes/No) * How would you describe your skin type? (e.g., oily, dry, combination, sensitive) * Do you have any medical conditions that could affect your skin or treatment? (e.g., eczema, rosacea, etc) * Are you currently pregnant or breastfeeding? (This may influence product usage.) * Have you had any recent cosmetic procedures (e.g., Botox, fillers, laser treatments etc)? if yes, when. * Do you prefer a relaxing facial or one that focuses on corrective treatments? or both? * Is there anything specific you would like us to avoid during your facial (e.g., extractions, specific products,etc)? * I give permission for before and after photos for treatment records/advertising. (Yes/No) * yes no How well would you describe you're at home daily skincare routine * not good sometimes good excellent Thank you!
