New Client Consultation Form - Skincare
This form is required if this is your first time being treated for any skincare services atThe Sugar Pot Beauty & Wellness Studio and it must be completed prior to your appointment.
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Email *
First and Last Name *
Date of Birth *
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Address *
Phone Number *
Gender *
Ethnicity *
Have you ever had a facial before? *
Have you ever had any body treatments before? *
Have you ever been to the dermatologist? *
What would you like to achieve from your treatment today? *
Do you have any long term skincare goals? If so, please explain. *
Have you ever had any of the following treatments? (check all that apply) *
Required
Do you currently use Accutane, Isotretinoin, Retin-A, Adapalene Hydroxyl Acid or any other Vitamin A derivatives? *
Have you ever used any medication for acne? *
Have you experienced Botox, Restylane or Collageb injections in the last 6 weeks? *
Do you have a current skin care regime? *
Please list all products that you currently use in your skincare regime and how often. (example: Skin Script Green Tea Cleanser - am/pm daily. If nothing write N/A) *
Have you used any hair removal methods in the last 72 hours? *
What areas of concern do you have concerning your skin? (Check all that apply) *
Required
Have you ever had an allergic reaction to any substance(s), not limited to, but including: fragrances, cosmetics, shellfish medication, food, pollen? *
List all allergies
Have you experienced any recent tanning? *
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