Phone (Cell)

When was your last facial treatment?

Please list any medications, skin care supplements or any treatments that could make your skin moresensitive / reactive (eg. Retin-A, AccuTane, chemical peel, laser hair removal, etc.)

Informed Consent.Print your initials below to acknowledge the consent

By signing this form, I consent to treatment and intend this consent to cover the treatment discussed with me and such additional treatment as proposed by my esthetician. I acknowledge that no assurance or guarantee has been provided to me as to the results of the treatment. I understand that at any time I may withdraw my consent and treatment will stop.I am aware of the 24-hour cancelation policy, If I fail to give 24-hour notice prior to my appointment, 50% of my service(s) will be charged on my credit card.I agree to be contacted periodically with special offers or services.

skincare consultation form