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Your Portal To A Personalized Skin Care Experience
New Client Intake Form
First Name
Last Name
Medical History
Have you had any Health conditions, skin conditions / disorders in the past or present?
Are you allergic to anything or had any allergic reaction to anything?
Do you use any Retinoids, Accutane or exfoliation products like salicylic acid, glycolic acid, lactic acid, or dermatology prescribed products
Have you had chemicals peels, laser treatments, or microdermabrasion in the last month?
Have you used any facial hair removal methods in the past week? (Wax,Laser, Nair, Theading, etc.)
*
Required
Yes
No
What are your skin goals?
Submit Form
Admission fee for this course is $10
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