Client Consultation

The mandatory form questionaire necessary before any treatment or consultation. A copy of this will be emailed to the client on submitting.

Client Consultation

Personal Details

Does your job require that you work outdoors?
What is your gender:

Your Skin Care

1. Have you ever had a facial treatment before?
2. Have you ever had a body spa treatment before?
3. Which of the following best describes your skin type?
4. Do you have any special skin problems or concerns pertaining to your face or body?
5. Have you ever had chemical peels, laser or microdermabrasion?
In the last month?
6. Do you use Retin-A, Renova, Adapalene Hydroxyl Acid or Retinol/vitamin A derivative products?
7. Have you used any of these products in the last 3 months?
8. Have you used an acne medication?
Which skincare products:
10. Have you recently used any self-tanning lotions, creams or treatments?
11. Have you used any of the following hair removal methods in the past six weeks?
Check all that apply:
12. What areas of concern do you have regarding your:
Skin:
Eyes:
Lips:
13. Have you ever had an allergic reaction to any of the following? (Please check any that apply and explain)
16. Have you had any recent tanning bed or sun exposure that changed the color of your skin?
17. Have you experienced Botox, Restylane or Collagen injections?

Female Clients Only

18. Are you taking oral contraceptives?
19. Any recent changes to or from your contraceptive treatment?
20. Are you pregnant or trying to become pregnant?
21. Are you lactating?
22. Any menopause problems?
23. Are you undergoing any hormone replacement therapy?

Male Clients Only

24. What is your current shaving system?
25. Do you experience irritation from shaving?
26. Ingrown hairs?

Future Appointments/Contact:

May I call you at your phone number to confirm future appointments?
May I contact you via mail/email about future promotions and news?