Skincare Touchbase Form

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