Full Name
Phone Number
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First name
Last name
CONTACT NUMBER
EMAIL ADDRESS
AGE
below 2121 - 3536 - 5051 & above
Which of the following services would you like a consultation for?
SKIN
AESTHETICS
BODY
Which statement best reflects how you want to look & feel?
I WANT TO LOOK LESS TIREDI WANT TO LOOK MORE YOUTHFULI WANT TO LOOK LESS SADI WANT A LESS SAGGY APPEARANEI WANT MY FACE TO LOOK SLIMMERI WANT TO LOOK MORE ATTRACTIVEI WANT SOFTER FEATURESI WANT TO LOOK LESS ANGRYOTHER
What is your present skin type?
DRYOILYCOMBINATIONSENSITIVENORMALMATUREACNE PRONE
What do you like about your skin?
CLEAR OR FLAWLESSHASSLE FREECOMPLEXIONSUPPLENESS
What do you dislike about your skin?
UNEVEN SKINTONEAGEINGACNEDARK CIRCLESSCARS OR FRECKLES
If you could enhance one aspect of your skin, what would it be?
HYDRATIONCOLOURELASTICITYSMOOTHNESS
How often to do get a facial?
Have you had a consultation or treatment for a cosmetic procedure before?
YESNO
What is your present skincare regime?
CLEANSETONEMOISTURISESPFNIGHT CAREMAKEUP
Any allergies or allergic reactions we should be aware of?
Are you pregnant?
Have you had waxing, threading or peel services done in the past 72 hours?
Thank you
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