Fitness Assessment Facial Consent Form
Fitness Assessment Facial Consent Form
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you had a facial treatment before?
*
Yes
No
Please rate your current skin condition
*
1
2
3
4
5
Do you have any known allergies to skincare products?
*
Yes
No
Select any current facial concerns
Dryness
Oily skin
Acne
Redness
Sensitivity
Other
Please indicate your comfort level with facial treatments
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Submit
Should be Empty: