RETURNING Client Form

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Email *

Name *

DOB *

YYYY

Cell Phone Number *

Email *

Address *

Has anything changed about your skin care? *

Has anything changed about your medical health or medications taken? *

Was there anything you liked or didn’t like about your last treatment that you want me to include or avoid today? *

Would you like to add one or more of the following services to your treatment today? *

Cooling Anti Stress Eye Rescue ($35)

Lip Rx Alone ($25)

Anti-Gravity Neck and Decollete ($40)

Leg & Foot Scrub ($35)

Rejuvenating Hand Treatment - (Peel or Hydrating) ($35)

Eyebrow Design ($25)

Other Facial Hair Removal ($20+)

Microdermabrasion added to Treatment ($55)

Extra 15 Minutes of Massage ($35)

Hydrating Jelly or Hydrating Sheet Mask ($25+)

Vitamin C Infusion $35

I do not wish to include any add ons

Required

Do you have any special requests, areas you want me to focus or specific services you prefer (as time allows) for today’s treatment? (specific areas of extraction, method of exfoliation,) *

I can go over the products I am using & recommend for you during your treatment or after.

What do you prefer?

During

After

Are you taking allergy medications or decongestants? *

Yes

Are you presently using Retin A or Glycolic Acid? (last 48 hours) *

Yes

PHOTO RELEASE: It is very helpful to be able to show the amazing results of our treatments.

Are you willing to grant permission for your aesthetician to use photos for marketing examples of their work.

We would be so grateful!

GRANT

NOT GRANT

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