• Client Consultation Form

    Hair and Skin Care Remedies Workshop
  • Format: (000) 000-0000.

  • Your Skin

  • What are your skin care challenges?*
  • Have you ever had a facial or skin treatment before?*
  • What Skin Care Products do you currently use?*
  • Do you/have you used Retin-A, Renova, Adapalene, Accutane, Differen, Glycolic Acid, Lactic Acid, Mandelic Acid, Retinol, or other Vitamin A derivitives?*
  • Have you received any of these hair removal services in the last 30 days?*
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments? *
  • Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?*

  • Your Health

  • Have you experienced any of these health conditions in the past or present?*
  • Do you take any of the following dietary / health supplements?
  • Any known allergies?*
  • Have you used or been prescribed any medications (topical or oral) for acne / acne control?*
  • Are you a smoker? *
  • Do you drink more than 4 caffeinated beverages a day? (tea, coffee, soda, energy drinks)*
  • Have you ever experienced claustrophobia? *
  • Please rate your stress level*
  • Any menopause issues? *

  • Disclaimer

    I hereby agree and understand that we are providing Home Remedies that are purely organic natural and safe to use. In case you see a reaction to any of the mentioned and applied remedies,it is advised that you immediately should stop the remedy and discontinue doing it. Since it is a normal awareness workshop and organic in nature, we do not foresee any side effect in the process. But having said that every Individual skin or hair will react differently according to their body immune system. Hence there would be various options shared per remedy, kindly apply the remedy that will suit your skin the best. In the course of doing the natural remedies any chemical peels or hair botox should not be done without our consultation. In case if it is done without our knowledge you will be solely responsible for your actions.

  • 5 Days Energy Exchange for INR 3000/-

    Kindly PM Screenshot of Payment Transfer for your Confirmation

  • Bank Details:    HDFC Bank

    Account Name: Kripa Prakash Velecha

    Account Number: 0652-10000-12678

    Bank IFSC CODE: HDFC0000652

    Mulund West Branch

    Mumbai 400 080

    Maharashtra, Mumbai

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