Wake Skincare Client Information First Name*Last Name*DOB* MM slash DD slash YYYY Address*Phone*Email* Have you ever had a facial before?* Yes NoDo you have any special skincare problems or concerns pertaining to your face or body?* Yes NoDo you use Retin-A, AHA, or Retinol derivative products?* Yes NoHave you ever had chemical peels, laser or microdermabrasion?* Yes NoHave you ever used acne medicine?* Yes NoDo you have any allergies?* Yes NoDo you have any metal in your face?* Yes NoAre you currently using any skincare products?* Yes NoAdd answer hereAnswer*Do you mind if your photo is used in social media?* Yes NoInitials*Do you mind if your procedure is recorded or photographed?* Yes NoConsent I confirm that the information given in this form is trueCAPTCHAΔ
