Client Information Form

CONFIDENTIAL

All fields below are mandatory.

1. How did you hear about us?

2. Please list any questions or concerns that you have with your skin?

3. Which skin care products are you currently using and how long? If None, type "None".

4. Have you been treated for any medical condition within the past year? If yes, please list.

5. List any medication or vitamins you are taking regularly.

6. Do you have any allergies to cosmetics or food? If No, type "No".

7.Any recent surgeries, including plastic or injectables dermal fillers? If yes, please list.

8. Do you use sunscreens?

9.What improvements would you like to see to your skin?

10. Any additional information your aesthetician should know about you and your skin, please list below:

Following the submission of this form you'll receive our email (within 48 hours) with the Virtual Service schedule options.