Client Intake | bijouskin.com

Are you a new or returing customer?

New-(Has not visited within 6 months)

Returning-(Has visited within 6 months)

Are you 18 years or older?

Yes

No-Parent or Guardian must fill out Intake Forms

Have you had any adverse reactions to skincare producs or facial treatments?

No

Yes

Are you taking any medications? Do you use any prescription skincare? ie. Accutane or Tretinoin

No

Yes

Do you have any allergies?

No

Yes

Are you currently experiencing any skin allergies, senstivities, or conditions?

No

Yes

Are you a smoker? (Tobacco, Hookah, Marijuana...etc)

No-I never smoke

Yes-I smoke regularly

Kinda-I smoke occasionally

Are you Pregnant or Breastfeeding?

I'm Pregnant

I'm Breastfeeding

Neither

Have you had any Facial/Dermatology/Cosmetic services or used any Retinoids in the past 30 days?

No

Yes

What type of skin do you have?

Are you currently using any products with actives or exfoliating ingredients?

No

Yes

Are you open to purchasing professional skincare recommended by your esthetician?

No, I prefer sticking with my current products

Yes, I'm open to try professional recommendations.

Maybe, It depends on the product

How often do you perform a skin care routine?

To achieve optimal results, a series of treatments along with a consistent and well-balanced skincare routine is recommended. How frequently do you anticipate scheduling facial treatments for yourself?

Once A Month (4-6 Weeks)

Every 2-3 Months

Every 4-6 Months

I'm not sure

BOOK YOUR FACIAL SERVICES CLICK HERE

Client Intake Form

Section Title

Client Intake Form

Please take a few moments to answer the following questions. Your responses will assist us in understanding your skincare needs and enable us to provide you with a customized service that caters to your skin's specific requirements. Submissions are MANDATORY 24 h
ours prior to your appointment.

BOOK YOUR FACIAL SERVICES CLICK HERE

Client Intake Form

Section Title

Client Intake Form

Please take a few moments to answer the following questions. Your responses will assist us in understanding your skincare needs and enable us to provide you with a customized service that caters to your skin's specific requirements. Submissions are MANDATORY 24 h ours prior to your appointment.

Please take a few moments to answer the following questions. Your responses will assist us in understanding your skincare needs and enable us to provide you with a customized service that caters to your skin's specific requirements. Submissions are MANDATORY 24 h
ours prior to your appointment.