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CLIENT INTAKE - FACIAL
Answering the following will be kept confidential. These questions help us better serve you in your sessions here at LAVA.
First Name
Last Name
Email
Phone
Do you have allergies If yes, which ones?
Have you had a chemical peel in the last 6 months?
Yes
No
Do you ever experience skin breakouts?
Yes
No
Have you ever experienced a reaction to any skin care products? If so which ones?
Within the last year, have you been under a dermatologist or other physicians care? If so what for?
Have you had any health problems past or present? If yes, please specify:
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