New Client Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastMobile *Emergency Contact *Email *Medical & Health HistoryDo you have any allergies? (products, ingredients, latex, etc.)Are you currently taking any medications? (topical or oral)Do you have any medical conditions? (asthma, eczema, rosacea, diabetes, etc.)Are you pregnant or breastfeeding?Do you have any active skin conditions or infections?Have you recently had Botox, fillers, or cosmetic treatments?Do you have any metal implants? (for certain machines)Skin HistoryDo you experience sensitivity, redness, or reactions?Have you had chemical peels, microdermabrasion, or facials recently?Do you use retinol, acids, or exfoliating products?Do you tan or use sunbeds?Daily skincare routine (cleanser, sunscreen, exfoliants, moisturisers)What Is Your Skin Type?DryOilyCombinationSensitiveNormalWhat Are Your Main Skin Concerns?(Acne, pigmentation, dryness, dullness, fine lines, texture, sensitivity, etc.)What results are you hoping to achieve?Preferred treatment type (if any)Water IntakeLowNormalHighStress LevelLowNormalHighSleep qualityLowNormalHighDiet notes (brief) use Intake Skin Smoking or alcohol useSmokingAlcoholNeither(These help explain breakouts, dullness, or sensitivity)Treatment RestrictionsAre you using Accutane / isotretinoin?Have you had recent waxing, laser, microneedling?Any recent sun exposure or upcoming outdoor events?Submit
