Thank you for taking the time to answer these questions. If you have an upcoming appointment, please try to fill this out at least 48 hours (more if you can!) in advance so that we have time to get your answers to your practitioner. This form may be used for new clients as well as returning clients and is not mandatory. Answer as many or as few questions as you want, just remember that that more truthful you are and the more information you give us, the better we are able to help you. Your answers will only be shared with our staff members to whom it is pertinent.

    ​General Intake Form / Contact Information

    ​Intake: History and Skin Concerns 

    In this first form, we take a look at your skin history and take note of your current skin concerns. Don't worry about getting things perfect, it is mostly so that we know where we are starting from and it can keep track of your progress!

    First Skin Concern
    Max file size: 20MB

    Second Skin Concern
    Max file size: 20MB

    Current Skin Care Regimen and Rituals

    We want to get an idea of what your current skin care regimen looks like. For best results, try to be as specific as possible.

    MORNING SKIN CARE
    ​***If you use our Moisture Duo

    EVENING SKIN CARE

    WEEKLY, SEASONAL, AND SPECIAL OCCASIONS

    IMPORTANT

    Self Care Intake

    So much of how we feel and how our skin looks depends on our self care. Here we are trying to both get a good overview of what your current self care looks like as well as perhaps pinpointing some little things that may show up in your life (or on your skin) as bigger things.
    Thank you for taking the time to fill this out. See you soon!