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Beauty Client Intake
A few questions before your first appointment so we can plan it properly.
Your name
*
(required)
Email address
*
(required)
Phone number
*
(required)
Date of birth
Your skin and health
How would you describe your skin?
*
(required)
Select…
Dry
Oily
Combination
Normal
Sensitive
Not sure
What would you like to work on?
*
(required)
Acne or breakouts
Pigmentation
Fine lines
Redness or rosacea
Dryness
Texture
Hair removal
General maintenance
Any allergies or sensitivities?
*
(required)
Any medication or supplements?
In the last month, have you had any of these?
Sunbed or heavy sun exposure
Waxing
Chemical peel
Laser or IPL
Botox or fillers
None of these
Are you pregnant or breastfeeding?
Select…
No
Yes
Prefer not to say
Your history
What treatments have you had before?
What do you use at home?
The information above is accurate to the best of my knowledge
*
(required)
You can contact me about my appointment
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