Skin Care Client Information

Name *
Name
Phone *
Phone
Address
Address
Date of Birth
Date of Birth
Spa Policy Acknowledgement *
Name *
Name
If yes, please specify in notes at the bottom of this form.
What skin care products are you using at home on your FACE? *
Check all that apply.
What products are you using on your BODY?
Check all that apply.
Skin History
Check if you have had any of the following:
Skin Type *
Check the one that BEST describes your skin.
Oil Secretion
Check the statements that are TRUE for your skin.
Capillary Activity
Check the statements that are TRUE for your skin.
Nerve Activity
Check the statements that are TRUE for your skin.
Skin Reactivity
Check any of the following that has caused a reaction in your skin.
Moisture Hydration *
Do you ever experience these conditions?
General Health
Check all that apply.
Please list any major health problems.
Female Clients ONLY
Check all that apply to you.
Male Clients ONLY
Check all that apply to you.