Aesthetic Treatment Pre-Visit Checklist Form
Please complete this checklist before your aesthetic treatment appointment to ensure the best experience. This form helps us confirm your readiness and comfort for your upcoming visit.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Appointment Date
*
-
Month
-
Day
Year
Date
Have you avoided using skincare products with retinol, acids, or exfoliants in the last 48 hours?
*
Yes
No
Have you refrained from waxing, laser, or other facial treatments in the last week?
*
Yes
No
Please confirm you will arrive with clean skin and no makeup.
*
I confirm
I need to discuss this with the provider
Please acknowledge you have read and understand the pre-visit instructions.
*
I acknowledge
If you have any questions or concerns for your provider before your appointment, please list them below.
Signature (to confirm checklist completion)
*
Submit Checklist
Submit Checklist
Should be Empty: