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Skin Alchemy HI

Transforming Skin, Enhancing Lives

Virtual Client
Intake Form

Transforming Skin,
Enhancing Lives.

Korean Facial

Virtual Client Intake Form

Please fill out this form, and I will send you your treatment plan within 3 - 7 days.


This form is for virtual clients who have already subscribed to the Virtual Client Program.

What type of virtual client would you like to be? You can change this later!
ASYNCHRONOUS: You prefer to connect only through email, our secure client portal, or text messages. There are no live video or phone calls, and everything is done at your own pace.
SYNCHRONOUS: You want scheduled, face-to-face time. You can choose Google Meet sessions, which incur a small fee for each meeting, or biweekly phone check-ins.
BOTH: You decide each month or before your biweekly check-in whether you would like to meet live or keep everything online through email, the portal, or text.
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 Type:

Your Skin History

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
Are you comfortable with your progress photos being posted on our social media or website?
Yes
No
What is your preferred budget for your skincare routine?
Under $180
$181–$400
No budget

Full routines typically start at an estimated cost of $180 or more. Please select the option that best fits your comfort level.

I have read and completed this questionnaire truthfully. I understand that withholding information or providing inaccurate details about my medical history, allergies, medications, and skincare routines may lead to contraindications or adverse reactions to the treatments I undergo. I agree to inform the technician of any changes in the above information.

Todays Date
Month
Day
Year

Please allow 3-7 business days to receive access to your client portal and skin consultation.

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This form is for virtual clients who'd like to skip the consultation and become a virtual client already!

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Virtual Skin Consultation Includes:

  • A detailed and comprehensive skin analysis via email

  • Tailored product recommendations with step-by-step guidance

  • Skin care knowledge on your unique skincare conditions and goals (plus skincare ebooks)

  • Access to Skin Alchemy HI Client Progress Tracker/Client Portal

  • Access to purchase products at a discounted rate!

  • For ongoing monthly support become a virtual client!

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***Products purchased separately

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