CONSULTATION FORM

First name

Phone Number

Last name

Date of Birth

Address

please select your skin type and list any skin concerns and desired outcome of your facial in the box below

Normal / comination

Oily Blimish Prone

Dry / Sensitive

Mature

Do have any known allergies to any previous skincare ingredient? Including carrier oils, essential oils, nuts & soya bean

Yes

If you answered yes to any question, please elaborate

DATE

I declare that the info I’ve provided is accurate & complete. I agree i will inform my therapist immediately of any discomfort at the time of the treatment so it can be delt with accordingly. I understand that i will take full responsibility of any injuries or worsening of any body or skin conditions NOT stated on this form or detailed health form presented at my booked appointment and waiver the right to make any claim against the therapist. At the time of my treatment i will ensure personal hygiene is at a satisfactory level.

Thanks for submitting!