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Please list all your allergies
Do you have any health problems or concerns that I need to be aware of before treatment, If the answer is yes, please describe?
Do you have any allergies?
Any recent surgery on your face, neck, and shoulders?
Any recent surgery on your face, neck, and shoulders?
Yes
No
If YES, please explain?
Are currently using or taking Accutane?
Are you using any other skin thinning products or drugs?
Are you a diabetic?
Yes
No
Do you use a tanning bed?
Yes
No
Are you exposed to the sun daily or will you spend more time out in the sun anytime soon?
Do you currently wear contact lenses?
Yes
No
Have you experienced Botox, Restylane or Collagen injections?
Please select the following conditions you have/had experienced?
Pacemaker or pins in bones
Metal plate
Cold sores
Warts
Lupus
High/Low blood pressure
Cancer
Anemia
Epilepsy
Hepatitis
Asthma
Seizures
Stroke
Headaches
Pregnant
Easy bruising
Skin infections
Accident or trauma
None
Please select that following that best describes your skin type:
Burns Easily
Never Tans, Always Burns
Tans Slightly, Burns Moderately
Tans Gradually, Seldomly Burns
Always Tans, Rarely Burns
Deep Tan, Never Burns
Deeply Pigmented
Are you under the care of a Dermatologist?
What are your skin concerns and challenges?
Covid-19 Health Declaration
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, cough, sore throat
