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Facial Consultation Form
Full name
Date picker
Birthday
Day
Month
Month
Year
Do you work outside for your job?
Never
Sometimes
Yes most the time
What would you like to achieve from your treatment?
Total relaxation
Results driven (I want advice with skincare)
Both are important to me
Have you ever had a facial treatment before
No
Yes
Skin Concerns
Acne/Breakouts
Oily
Uneven Texture/Scarring
Rosacea
Redness
Sensitivity
Fine Lines & Wrinkles
Sun Damage
Ageing
Enlarged Pores
Discolouration/Dull
Dark Under-eye Circles
Milia
Psoriasis
Flaky Skin
Dry Spots
What is your skin type?
Normal
Dry
Oily
Combination
How does your skin feel?
Flaky
Reddish
Tight
Excessive oil
Normal
Do you use sunbeds?
No never
Yes
How does your skin heal?
Fast
Slow
Scars
Pigments
Do you bruise easily?
No
Yes
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