top of page

Save time- complete your new client intake forms ahead of time.  

Facial Intake form
 

Please fill out the following form prior to your first FACIAL with Serendipity Wellness Studio.  also please complete if it has been over 1 year since your last facial with us, or have had any major health changes

Have you undergone any sugeries in the past year? Required
Are you under the care of a dermatologist? Required
Please check if you have ever had any of the following:
Are you allergic to aspirin? Required
Are you allergic to Aloe Vera? Required
Do you use Retin-A? Required
Have you ever used Accutane? Required
Do you have any implanted metal devices? Required
Do you smoke? Required
Do you have any allergies? Required
What types of skincare products are you currently using?
Are you achieving the desired results with your current beauty regimen? Required
Do you experience oily shine during the day? Required
Do you experience skin breakouts? Required
Do you take laxatives or diuretics? Required
Do you experience any of these skin conditions?
How many cups of caffeinated beverages do you drink daily?
Do you burn easily in moderate sunlight? Required
Do you take any diet pills or other stimulants? Required
Have you ever had a reaction to any of the following:
Have you ever experienced claustrophobia? Required
FEMALE CLIENTS ONLY: Are you taking oral contraception?
FEMALE CLIENTS ONLY: Are you pregnant or attempting?
FEMALE CLIENTS ONLY: Are you currently having or are due for your menstrual period?
MALE CLIENTS ONLY: What is your current shaving system?
MALE CLIENTS ONLY: Do you experience irritation from shaving?
MALE CLIENTS ONLY: Do you experience ingrown hairs?

Thanks for submitting! We are looking forward to seeing you!

© 2022 by Serendipity Wellness Studio   Proudly created with Wix.com

  • Grey Facebook Icon
  • Grey Twitter Icon
bottom of page