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NEW CLIENT FORM - FACIAL

Birthday
Gender
Female
Male
Appointment Date & Time
:
Do you have any allergies, skin sensitivities, or skin conditions?
Yes
No
Have you had a chemical peel, microdermabrasion, laser treatment, or any skin resurfacing treatment within the last month?
Yes
No
Have you used any Retin-A/retinol/tretinoin or any other exfoliating skin product in the last week?
Yes
No
Are you pregnant or lactating?
Yes
No

Facial treatments are designed to improve the skin by resurfacing the skin. You may experience temporary burning, itching, or stinging with any of our facials. It is important that you strictly adhere to the Pre & Post care regimen and product recommendation from there skin therapist.

There are no guarantees as to the results of a treatment due to many variables such as age, condition of skin, sun damage, smoking, climate, home care regimen, etc. To achieve maximum results, you may need several treatments. In the rare event that complications occur you must contact Island Skin Spa immediately at 671-989-7546 or email at islandskinspa@gmail.com.


You must refrain from prolonged outdoor activities for 7 days prior and 7 days after a deeply exfoliating treatment (peel, microderm, dermaplaning, etc). Extended sun exposure may make your skin more sensitive and minimize results of your facial treatment. We recommend the daily use of sunscreen protection with a minimum of SPF30.


There may be some degree of discomfort during and after a facial peel such as stinging, pin-prickling sensation, heat, or tightness. After a peel you may experience dry peeling, which at first may appear darker before it peels off. You should not pick or scratch at dry skin, as doing so may cause hyperpigmentation. You may or may not actually peel as each case is individual. The amount of peeling does not correlate with the degree of skin improvement.


Pre and Post Care Instructions may be found online at https://www.islandskinspa.com/facialfaq. You should follow your esthetician's recommendations for post-procedure skin care to maximize results and minimize side effects. Island Skin Spa provides retail products to safely maximize the effectiveness of your facial treatment.

By signing below, I am acknowledging that I have read, understood, and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contra-actions and/or irritation to the skin/body from treatments received. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof. I understand the above consent and will follow all aftercare instructions either given verbally, written, or from https://www.islandskinspa.com/facialfaq.

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