Skincare Touchbase Form
* Required
Name
*
Your answer
Any health, allergy or prescription updates your technician should be aware of?
Yes
No
Have you used any chemical exfoliants in the last week? (like Retin A, AHA’s or BHA’s)
Yes
No
Not sure
Any chance of pregnancy?
Yes
No
Have you had any fillers or dermatological procedures in the last month?
Yes
No
What is the reason for your visit today?
Relaxation
Results
Both
What type of aromatherapy do you prefer?
Floral
Citrus
Woodsy
I don't like fragrance
If applicable, would you like a scalp massage today?
Yes
No
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