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19 views1 page

Fillable PDF Paper True

Uploaded by

harsh.singh710988
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Client Consultation Form

Client Information and Consent


BORCELLE

Name

DOB Occupation IT admin

Address

City Zip

Phone Email

SKINCARE HISTORY Yes No

1. Do you have any experience with facial treatments or chemical peels?

2. Do you use skincare products for acne and anti-aging?


3. During the past 48 hours, have you used skincare products for treating
surface wrinkles, improving skin texture and tone, unblocking and
cleansing pores?
4. Do you take medicine to reduce the amount of oil released by oil
glands in your skin or have you taken it in the past?
5. Do you use a tanning bed or are you exposed to the sun daily?

What skincare products are you currently using?

1. 4.

2. 5.

3. 6.

I am aware that it is my duty to submit truthful information.


I agree to the terms of service

Date

Signature

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