top of page

Client Intake & Consent Form

Thank you for booking your appointment. Please fill out these forms 24 hours prior to your appointment. In the event that there are any contraindications to your service we may need to reschedule your session.

Thank you!

Date
Month
Day
Year
Have you ever had a facial before?
Yes
No
Do you currently have an active cold sore on or around your lips or face? Please note: If you have an active cold sore at the time of your appointment, we will be unable to proceed with your treatment and need to reschedule.
Yes
No
How would you describe your skin?
Are you under treatment for any current skin condition?
Yes
No
Have you ever used:
Have you had any Botox or Filler in the last 30 Days? If so, your appointment will need to be rescheduled:
Yes
No
Are you allergic to anything?
Yes
No
Are you currently pregnant?
Yes
No
Do you sunbathe or tan?
Yes
No
Do you regularly use sunscreen?
Yes
No
Do you consent to photos during or after your service? These photos may be used in your client chart to document progress and/or used on our social media accounts?
During my session, I prefer:
A quiet, peaceful experience with minimal conversation
Light conversation throughout the session
I’m open to either – follow your lead!
bottom of page