Consultation Form
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Email *
Full Name *
Phone Number *
City *
Age *
Date of Birth *
MM
/
DD
Occupation *
How did you find me? *
Have you had a facial treatment before? If yes, how long ago? *
How often do you have facials? *
Have you ever had: *
Required
Have you had any skin procedure in the last 2 weeks? (Surgery, Laser, Chemical Peels, Microdermabrasion, Botox, Fillers, Other) Please specify if any, and date. *
Please check your specific skin care concerns *
Required
If "other concern" please specify 
Please check the skin care products you are currently using at home *
Required
What sunscreen are you currently using on your face? How often? *
Are you currently using any product that contain *
Required
Are you currently using any prescribed topical cream? If yes, which one? *
Have you ever had a reaction to skin care products or ingredients? *
If yes, what kind of reaction/product/ingredient
Any known allergies that affect your skin? *
Required
If "Other Allergy" please detail here...
Have you used any face hair removal method in the past 7 days (waxing, sugary, threading, laser)? If yes, please specify *
Are you currently wearing eyelash extensions?
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Please check all conditions you have, or have had in the past *
Required
If " Other condition" please detail here
Are you currently under the care of a physician? *
If yes, please explain here *
Are you pregnant, lactating? If pregnant, how many weeks?
Are you taking oral contraceptives?
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If you shave your face, what is your current shaving system?
Do you experience irritations from shaving? If yes, please explain.
CLIENT CONSENT
I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. *
Required
I have voluntarily elected to undergo facial treatments and procedures offered by Lavao Skincare and hereby consent to and authorize Lavao Skincare to perform the services as explained and agreed during the consultation session. *
Required
I understand that after the facial (esp. Nanofacial), in rares cases, the skin will be pink and flushed in appearance. You may also experience skin tightens and mild sensitivity to touch or sweeting on the facial area. *
Required
I give my consent to Lavao Skincare to take photographs and/or videos of me during my facials. *
I give my permission for Lavao Skincare to post any videos or photos of services performed on me and any related information to its social media sites including its website, Instagram and Facebook in order to inform others about services, methods and results. *
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