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Facial At Home Intake Form- Apsara Spa
Please complete the following form as thoroughly as possible to help us create the best facial for you.
Name *
Full Address *
Best number to reach you *
Best email to reach you *
What is the one thing you love about your skin? *
What is the one thing you would change about your skin? *
How old are you? *
How often do you receive facials? *
Are you allergic to any cosmetic ingredient, medication or food? *
If yes please list.
The following information is essential to optimize the results of your service. Which concerns apply to your skin? Please check all that apply: *
Required
Please list any skin concerns/ issues that are going on with your skin now? *
Please all skincare products you are using and brands. This will help us to maximize your results. *
I have been advised the service(s) provided to me by this spa could have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, soreness, etc. I am aware that certain medications and over the counter products can significantly increase the risk of injury when combined with skin care services. I understand that Apsara Spa does not recommend facial services for customers using Retin-A, Accutane and products contacting alpha hydroxyl, or any other skin thinning treatments. I hereby confirm that I am not using any medications that may cause or contribute to such injury/reaction, and I will advise my esthetician should I use any such medications in the future. I will not hold Apsara Spa and Esthetician liable. *
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