Fillable Spa Sweet New Client Questionnaire %E2%80%93 Facial

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Spa Sweet New Client Questionnaire %E2%80%93 Facial

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"#$!%&'#()!*+#,)'-((.'/#!0!1.2'.&!
!!!!!!!!!Name__________________________________!Date!__ _ _ _ __ _ _ _ _ _____!
!
Address_________________________________________!City____________________State________!Zip!Code___________!!
Phone___________________________________!Em ail_ _ _ ______________________________________________________!
3.4#!5-+!6.7!.!8.2'.&!9#8-/#:!Yes_______!No______ _!
;6.)!./#!5-+/!,<#2'8'2!,='(!2./#!2-(2#/(,:!!
Dry/Flaky______!Age/Sun!spots______!Fine!Lines______!Excess!oil______!Redness / S en s itiv ity _ _ ____!Blackheads______!!
Breakouts_____!None_____Other_________________________________________________________________________!
;6.)!,='(!2./#!</-7+2),!./#!5-+!2+//#()&5!+,'(>!.)!6-?#:!
Cleanser______!Toner______!Exfoliant/Scrub______!Serum______!Day!Moisturizer______!Night!Moisturizer______!!
Eye!Cream______!Brand(s):!______________________________________________________________________________!
@/#!5-+!</#>(.()A!&.2) .) '( > !- /!< &. ( !- (!9#2-?'(>!</#>(.()!,--( :!No______!Yes_____ _!
B',)!.&&!=(-$!.&&#/>'#,!C8--7A!</-7+2),A!'(>/#7'#(),A!?#7'2.)'-(A!#)2DE!
_____________________________________________________________________________________________________!
3.4#!5-+!#4#/!6.7!.!/#.2)'-(!)-!,='(!2./#!</-7+2),!-/!'(>/#7'# ( ), : !!No______!Yes______!!
Please!explain_________________________________________________________________________________________!
@/#!5-+!+,'(>!.(5!</#,2/'9#7!#F8-&'.(),:!CG#)'(H@A!I'8#/#(A!G#(-4.!#)2DE!!No______!Yes______!!
How!often____________________________________________________________________________________________!
@/#!5-+!+(7#/!)6#!2./#!-8!.!7-2)-/!8-/!.(!.+)-!'??+( # !7 ', - /7#/:!!No______!Yes______!!
@/#!5-+!2+//#()&5!).='(>!.(5!?#7'2.)'-(!)6.)!2-+&7!'()#/8#/#!$')6!.!8.2'.&!)/#.)?#():!!!No______!Yes!_____ _!!
Explain___________________ ______________________________________________________ ______________________!
3-$!?.(5!-+(2#,!-8!$.)#/!7-!5-+!7/'(=!7.'&5:!__________!
J(!.4#/.>#A!6-$!?.(5!6-+/,!-8!,&##<!7-!5-+!>#)!#.26!('>6):!_______ _ __!
J(!.!,2.&#!-8!KHKL!$6.)!',!5-+/!2+//#()!,)/#,,!&#4#&:!__________!
I-!5-+!).=#!,+<<&#?#(),M4').?'(,:!Yes____ _ _!No_____ _!
G#8#//#7!N5:!____________ _ _ _ __ _ _ _ _ __ _ _ _ __ _ _ _ _ __________________________________________________________!
I!understand!that!redness,!sensitivity,!peeling!or!other!reactions!may!occur!from!facial!treatments.!If!I!experience!any!discomfort!during!the!session,!I!
will!immediately!inform!the!esthetician!so!that!the!products!and/or!technique!may!be!adjusted!to!my!level!of!comfort.!I!further!understand!that!
estheticians!are!not!qualified!to!diagnose,!pres cr ib e !o r!tre a t!a n y ! disease!or!illness!and!tha t!a!fa cial!sho u ld!no t!be !a!rep lacem e nt !fo r !medical!treatment.!
The!treatments!I!receive!here!are!voluntary!and!I!release!Spa!Swe et !LLC!and/or!skin!care!professional!from!liability!and!assume!full!responsibility!
thereof.!
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Spa Sweet New Client Questionnaire %E2%80%93 Facial

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Completed 17 February 2021

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