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FACIAL FORM

The following information will be used to help plan a safe and effective treatment. Please answer the questions to the best of your knowledge. All information will remain private and confidential.

Are you currently pregnant or nursing?
Are you currently on any medication with a “skin/sun sensitive” warning label?
Do you have epilepsy or take medication to prevent seizures?

Why do we ask if you're on any medication?

  1. Safety: Certain medications can interact with skincare products or treatments, potentially leading to adverse reactions or complications. By knowing what medications you're taking, we can ensure that the products and techniques used during your facial are safe for you.

  2. Skin Sensitivity: Some medications can make your skin more sensitive or reactive. This information helps us choose the most suitable products and adjust the treatment to minimize the risk of irritation or discomfort. 

By considering your medication use, we can ensure that your facial treatment is as effective as possible.​

Do you have any metal implants or a pacemaker?
What type of skin do you have?
What time of day do you show excess oil production?
How much water do you drink per day, on average?

What products do you currently use? Check all that apply

What are your skin care goals?

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