Consent Form

Within the last year, have you been under a dermatologist's or other physician's care?

Do you wear contact lenses?

Have you had any health problems in the past or present?

Do you have metal implants, a pacemaker or body piercings?

Have you ever experienced claustrophobia?

Have you had a chemical peel, microdermabrasion, laser or light therapy, an injectable, or other cosmetic procedure in the last month?

Have you waxed within the last 72 hours?

Do you use Retin-A, Renova, Adapalene, or any other prescription skin products?

Do you have any allergies? 

What skin care products are you using?

Are you pregnant or trying to become pregnant?

Are you currently using any products that contain the following ingredients?

List any medications, supplements, vitamins, etc. that you take
regularly: 

Have you taken isotretinoin (accutane) within the last 6 - 12 months?

What are your specific concerns or challenges with your skin?

Your Health

Your Skin

face:

body:

Female Clients

Are you breastfeeding?

Are you prone to cold sores or fever blisters?

Thank you for submitting