Joyful Complexions Facial Intake Form
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Email *
Name *
Phone number *
Email *
Birthday
Health Conditions
Current Medications, and what they are for? *
Topical Prescriptions *
Required
Allergies? *
Skin Concerns/ Improvements? *
Required
Pregnant or Lactacting? *
History of Keloid Scarring? (Prone to raised scars) *
What pressure massage would you prefer?
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Types of Hair removal used?
Have you had any neurotoxin or filler in the past 2 weeks?
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Have you ever had a reaction to any type of hair removal, or cosmetics? *
Do you wear contacts? *
How much sun exposure does your skin have? *
Do you wear SPF? *
What previous Advanced Skin Treatments have you had in the past, and roughly when? How did your skin react? *
What skincare products do you use? *
Are there any request I can help achieve during your appointment? *
Required
Are there any questions you have for your esthetician?
Do I have your consent to use any pictures or videos used from during the service? Please say Yes or No and list your first and last initial.
“Signature” of Parent or Guardian needed if not at least 18 years of age. Please write name and relationship to client.
Thank you for filling out the Facial Intake from!
If you have any questions please let me know!
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