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Skin Alchemy HI

Transforming Skin, Enhancing Lives

Korean Facial Mummy Mask

SKIN ALCHEMY HI

Transforming Skin,
Enhancing Lives.

Facial Consultation Form

Please fill out this form so I can prepare for your facial!

A lot of the questions on this form are optional! You can skip the non required questions if you are unsure!

Your Skin Concerns
Medical History | Do you have any of the following conditions? If yes, please select them:
Any known allergies?
Yes
No
Any recent surgery, including plastic surgery?
Yes
No

Female clients

Are you pregnant or trying to become pregnant?
No
Yes
Are you taking birth control pills?
No
Yes
Are you undergoing any hormone replacement therapy?
No
Yes

Your Lifestyle

What is your sun exposure?
Do you use sun protection (sunscreen, hats, protective clothing)?
No
Yes
Do you use tanning beds?
No
Yes
Do you smoke?
No
Yes
Do you drink more than 4 caffeinated beverages a day?
No
Yes
What is your alcohol consumption?

Your Skin History

Your Skin Type:
Have you ever had an allergic reaction to any of the following?
Are you currently using products containing any of the following ingredients?
How does your skin heal?
Fast
Slow
Scars
Pigments
Do you get bruises easily?
No
Yes
Have you received Botox, Restylane, or Collagen injections in the last 6 months?
No
Yes
Which services are you most interested in from our FREE modality list? The free modality list is included in all of our signature facials and some of our specialty facials.

Please note: While you may select up to 6 modalities, not all may fit into a single facial. We'll prioritize your top choices to create the most effective treatment for your skin.

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