Beauty Service Contraindication Form
Please complete this form to help us determine your suitability for beauty services and identify any relevant concerns or precautions.
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 experienced any skin reactions or allergies to beauty products in the past?
*
Yes
No
Are you currently taking any medications or supplements that could affect your skin or treatment results?
*
Yes
No
Do you have any ongoing skin conditions (such as eczema, psoriasis, or acne)?
*
Yes
No
Are you currently pregnant or breastfeeding?
Yes
No
Have you received any cosmetic treatments (such as peels, waxing, or injections) in the past 4 weeks?
*
Yes
No
Are there any areas of your skin with open wounds, cuts, or recent sunburn?
*
Yes
No
Is there anything else you would like us to know before your beauty service?
Submit
Should be Empty: