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Client Consultation

Welcome to Beauty Etc - please complete the form below prior to your first treatment.

Your details
Your medical history
Please tick if you suffer (or have ever suffered) from any of the following Required
Do you currently have any medical conditions not listed above?
Do you take Accutane?
Do you use a retinol serum/cream?
Have you had radiation or chemotherapy treatments in the past 12 months?
Have you had recent surgery (in the last 12 months) on the area to be treated?
Are you currently pregnant, trying to become pregnant or breastfeeding?
Do you wear contact lenses?
Do you exercise?
Do you smoke?
Your skin details
Are you concerned about the following skin conditions (tick all that apply) Required
When you go out into the sun, do you (tick one)

Please rate the following skin goals from 1 (least important) to 5 (most important)

Reduction of fine lines
Least importantNot very importantNeutralImportantMost important
Reduction of brown spots/sun damage
Least importantNot very importantNeutralImportantMost important
Reduction of oil/acne
Least importantNot very importantNeutralImportantMost important
Acne scars diminished
Least importantNot very importantNeutralImportantMost important
Reduction of redness
Least importantNot very importantNeutralImportantMost important

Thanks for completing the new client consultation form!

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