Please complete the facial consultation questions before confirming your booking.
Personal Information
First Name
Last Name
Email
Date of Birth
Phone Number
Your Health
Within the last year, have you been under the dermatologist's or another physician's care?
Select…
Yes
No
Dermatologist or physician care details
Have you had any health problems in the past or present?
Select…
Yes
No
Health problem details
List any medications, supplements, vitamins, diuretics, slimming pills, or similar products you take regularly.
Do you smoke?
Select…
Yes
No
Do you exercise regularly?
Select…
Yes
No
Do you follow a restricted diet?
Select…
Yes
No
Do you wear contact lenses?
Select…
Yes
No
Do you have metal implants, a pacemaker, or body piercing?
Select…
Yes
No
Stress Level (0-5)
0 = low stress, 5 = high stress.
Select…
0
1
2
3
4
5
Do you have any allergies?
Select…
Yes
No
Do you sunbathe or use tanning beds?
Select…
Yes
No
Do you drink more than 4 caffeinated beverages daily (coffee, tea, soft drink)?
Select…
Yes
No
Have you ever experienced claustrophobia?
Select…
Yes
No
Your Skin
What are your specific concerns or challenges with your skin?
Have you ever had chemical peels, microdermabrasion, or another resurfacing treatment?
Select…
Yes
No
Do you use Retin-A, Renova, Adapalene, or other prescription skin products?
Select…
Yes
No
SPF Sunscreen used (Face)
SPF Sunscreen used (Body)
Do you burn easily in moderate sunlight?
Select…
Yes
No
Do you have a tendency to redness?
Select…
Yes
No
Do you suffer from sinus problems?
Select…
Yes
No
Do you ever experience burning, itching, or stinging sensations on your skin?
Select…
Yes
No
Skin type
Select…
Normal
Dry
Oily
Combination
Sensitive
Current skincare routine or products used
Any recent facial peels or cosmetic procedures?
Select…
Yes
No
Female Clients Only
Only answer these questions if relevant.
Are you taking oral contraception?
Select…
Yes
No
Are you pregnant or trying to become pregnant?
Select…
Yes
No
Are you lactating?
Select…
Yes
No
Are you currently having or due for your menstrual period?
Select…
Yes
No
Male Clients Only
Only answer these questions if relevant.
Do you have any shaving challenges?
Select…
Yes
No
Shaving challenge details
Have you started any new medication since your last visit?
