Medical Info Please enable JavaScript in your browser to complete this form.Full name *Email *Phone number *Place of Birth *Date of Birth *Age *Reason for Visit *How would you describe your skin type? *SelectNormalOilyDryCombinationI don't knowSkin Issues (if any)SpotsAcneWrinklesSensitivityRosaceaOtherIf selecting "Other," please specifyDo you have any cosmetic concerns?Have you had previous facial procedures? *YesNoDo you use at-home facial care products? *Do you have a known allergy to facial care products or ingredients or to any type of food? *Do you have any medical restrictions or conditions that should be considered during facial procedures? *Are you pregnant or breastfeeding? *YesNo"How would you rate your overall satisfaction with your current facial appearance? (On a scale of 1 to 10, with 1 being very unsatisfied and 10 being very satisfied) *Additional comments or questionsSend Covid-19 Health Declaration Please enable JavaScript in your browser to complete this form.Full Name *Email *Phone number * *My body temperature is below 98.6°F / 37.5°CI am not experiencing the symptoms: fever, cough, sore throat, difficulty breathing.I have not been in close contact with a COVID-19 patient in the past 14 days.Initials *Date * *I declare that the information I have provided is accurate and complete.Send
