Facial Treatment Client Intake Form

Due to COVID-19, we are temporarily limiting the number of daily appointments. The health and safety of our clients and staff is very important to us. For this reason, walk-in appointments will not be accepted and clients who are not currently receiving a service will be asked to step out in order to control the number of people within the salon/spa/clinic. If you are experiencing a fever, cough, or sore throat, please reschedule your appointment for when you are no longer symptomatic. If you have been to a COVID-19 impacted area or have been in close contact with a person infected with COVID-19, we ask that you please reschedule your appointment for 14 days past the date of contact. Please note, we are requesting that clients wear face coverings when they arrive for their appointments.

Contact Information

Your Skincare Routine

1 begin no stress 10 being lots of stress
Please list all allergies and explain.

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.