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Pre-Treatment Questionaire

Birthday
Day
Month
Year

Health History

Are you currently under the care of a doctor for any medical conditions?
Yes
No
Are you currently pregnant or breastfeeding? (Some treatments may not be safe during pregnancy.)
Yes
No
Do you have any skin conditions or sensitivities? (E.g., eczema, psoriasis, acne, rosacea)
Yes
No
Do you have any history of skin reactions to products or treatments?
Yes
No
Do you have any history of skin reactions to products or treatments?
Yes
No

Current Medications and Treatments

Are you currently using any skin medications or treatments? (For example, Retinol, Accutane, etc.)
Yes
No
Do you use any treatment or products at home (cleanser, toner, serum, eye-cream, day/night cream, SPF) ?
Yes
No
Do you have a history of using medication that affects your skin?
Yes
No

Lifestyle Questions

How often do you use skincare products at home?
Every day
Once in a week
Once a fortnight
Option Once in a mounth
Never
Do you have any habits that might affect your skin? (E.g., smoking, sun exposure, lack of sleep, diet)
Yes
No
Do you wear makeup regularly? (Some treatments may need to consider makeup removal or how to handle products.)
Yes
No

Other Feedback

Consent and Acknowledgment

How did you hear about us?
Word of mouth Referral from a friend/family
Google Maps/Location services
Flyer or brochure
Social media
Special offer or gift voucher
Attended a salon-hosted event
Through a beauty product I purchased
Magazine or newspaper article
Other
Do you consent to the therapist performing the treatments booked?
Yes
No
Do you understand and accept the risks involved with certain treatments (e.g., peel, microneedling)?
Yes
No
Do you consent to having photographs taken for your treatment record and / or marketing?
Yes
No
Would you like to be contacted for future promotions or appointments?
Yes
No
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