Client Intake Form-Facials
How would you describe your skin?*
Have you ever received the following procedures?*
What skincare products do you use on a daily basis?*
Have you used any of the following topical/ oral dermatological medications?*
Are you currently taking birth control pills or have an IUD?*
Are you currently pregnant or breastfeeding?*
Are you currently experiencing Perimenopause or Menopause?*
Are you currently undergoing any hormone therapies or taking infertility medications?*
How often do you consume alcohol?*
How often do you consume caffeine?*
How often do you consume tobacco?*
How often do you consume marijuana?*
How often do you consume water?*
How often do you consume sugar?*
Are you having atleast one bowel movement a day?*
Have you had excessive sun exposure in the last few days?*
Will you be having excessive sun exposure on vacation or in the near future?*
Are you in the habit of using tanning booths?*
Have you ever had any of the following conditions?*
Do you have any other medical concern that has not been covered in this form?*
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