• Format: (000) 000-0000.

  • Your Skin Journey

  • How would you describe your skin type?*
  • Have you ever had a facial?*
  • Which skin conditions would you like to improve?*
  • What areas would you like to improve?*

  • Your Daily Skin Care

  • Please list the product names and brands. This is important to identify any products that may not be a good fit for your skin.
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  • Your Medical History

  • Have you experienced a reaction to a topical product?*
  • Do you have any Food Allergies or Sensitivities?*
  • Do you have an implanted IUD?*
  • Are your eyes very sensitive to bright lights?*
  • Do you experience claustrophobia?*
  • Are you pregnant or breastfeeding?*

  • Prepare for your appointment:

    • You will recieve a confirmation email/text one week prior to your service. PLEASE CONFIRM your appointment through the link provided.
    • Discontinue exfoliation (scrubs, peels, AHA/BHA serums) at least 3 days prior to your treatment.
    • Discontinue prescription retinoids (Retin-A) 5-7 days prior to your treatment.
    • Wait 1-2 weeks AFTER Botox™ or consult your injector.
    • Wait 7 days -2 weeks AFTER filler or consult your injector.
    • DO NOT PLAN intense workouts/sweating/sauna/spa for 24-48 hours after your facial treatment.
    • If you are prone to cold sores/fever blisters, you may need a prophylactic like Valtrex prior to your facial. Consult your Doctor.
  • Date*
     - -
  • Signature*
  • Should be Empty: