Hello

 

Welcome

Hello there! Here are a few things to touch base with you. Please fill up and submit the intake form below A.S.A.P. this way we can speed up our consultation time and allow us to have more time for more pampering that you deserve!


Important Details

1. Please be familiar with some frequently ask questions by reading Spa FAQ page
2. It is best to fill out the intake form A.S.A.P. do not procrastinate. Life is stressful enough as it is, plan ahead get into the zone you should be as carefree as possible and enjoy a wonderful treatment when you are here!
3. Your necklace will need to be removed prior your service. Make it a habit to keep all jewelry at home or in your purse before you head into your service.


Honesty

Your honesty is very important to your treatment. There won't be any judgment on what you use or what you do to your skin. However, suggestion will always freely give to you to help us to achieve a better skin health. Please note that you will be refused to receive any facial treatment if it is not the right time for your skin at the moment.

Please complete the form below

 
 
 

Step #1:

Lifestyle intake

 

 
Name *
Name
Best Phone # *
Best Phone #
Emergency Contact (Name) *
Emergency Contact (Name)
Emergency Contact (Phone#) *
Emergency Contact (Phone#)
1. Within the last year, have you been under a dermatologist’s or other physician’s care? *
2. Have you had any health problems in the past or present? *
3. List any medications, supplements, vitamins, diuretics, slimming pills, Isotretinoin, etc. that you take regularly. *
4. Do you smoke?
5. Do you follow a restricted diet?
6. Do you wear contact lenses? (If you do wear contact lenses, IF it is possible, do not wear your contact lenses on the day of service.)
7. Do you have metal implants, a pacemaker, body piercings, botox, filler?
It is best to not to wear any body piercing during your service, such as nose ring or earrings.
8. Rate your level of stress on a scale of 1 -5
9. Do you have any allergies? *
10. Are you a "sun-worshiper" or use tanning beds?
11. Do you drink more than 4 caffeinated beverages daily (coffee, tea, soft drinks)?
12. Have you ever experienced claustrophobia?
13. Where are your products from?
14. What skin care products are you currently using? *
15. Have you ever had chemical peels, microdermabrasion, or any resurfacing treatments? *
16. Do you use Retin-A, Renova, Adapalene or any other prescription skin products? *
17. Have you use any of the following in the last 3 months?
18. Are you currently using any products that contain the following ingredients? *
19. Do you ever experience these conditions on your skin?
20. Do you use any SPF?
21. Do you...
22. How religious are you with your skincare routine? *
23. Have you started any new medication recently? *
FEMALE ONLY:
MALE ONLY:
It's best to keep all jewelry out and store in your purse or at home before service. Thank you! We will meet soon!
By checking this box, I believe all is true to the best of my knowledge. *
By checking this box, I understand pictures of my skin will be taken for progress documentation & educational use. *
 
 
 

Please complete the Next form