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Intake Form

Skin Care Intake Form

Skin Care Experience

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof. I have completed this information form to the best of my knowledge.

By submitting this form you confirm you have read and accepted the terms and conditions

August 14, 2020