Skincare Consultation Form Client Information and Consent Name Date of Birth Occupation Address City Zip Code Email Address Phone No. Skincare History Do you have any experience with facial treatments or chemical peels? Yes No Do you use skincare products for acne and anti-aging? Yes No During the past 48 hours, have you used skincare products for treating surface wrinkles, improving skin texture and tone, unblocking and cleansing pores? Yes No Do you take medicine to reduce the amount of oil released by oil glands in your skin or have you taken it in the past? Yes No What skincare products are you currently using? Yes No Do you use a tanning bed or are you exposed to the sun daily? Yes No What skincare products are you currently using? I am aware that it is my duty to submit truthful information. I agree to the terms of service Submit
