CLIENT INFORMATION

    Name
    Date of Birth
    Phone
    Email
    Emergency Contact

    PRIMARY TREATMENT INTEREST

    Main concerns / goals

    MEDICAL & HEALTH HISTORY

    SKIN & LASER HISTORY

    Fitzpatrick Type

    LIP BAR

    Have you ever had lip filler?
    If yes, when?
    Do you have a history of cold sores?
    Have you used Retinol around the mouth recently?
    Are you sensitive to mint?

    JAPANESE HEAD SPA

    BODY SCULPTING & WELLNESS BAR

    AYURVEDIC & HOLISTIC PREFERENCES

    Pressure Preference

    CONTRAINDICATION REVIEW

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