top of page

Appointment  Details

Kinshasa Washington

15-Dec-21
PRE - Treatment Notes

AFTER REVIEWING THEIR CONSULTATION FORM, WHAT TREATMENT DO YOU RECOMMEND AND WHY?

HOW HAS THE CLIENT'S SKIN BEEN SINCE THEIR LAST TREATMENT? WHAT EXACTLY DID THE CLIENT OBSERVE ABOUT THEIR SKIN?

WHAT EXACT REGIMEN IS THE CLIENT CURRENTLY FOLLOWING DAILY? LIST ALL PRODUCTS.

WHAT CHANGES WOULD YOU RECOMMEND NEED TO BE MADE TO THEIR REGIMEN IF ANY? (ADDITIONAL PRODUCTS, REDUCE USAGE OF A SPECIFIC PRODUCT ETC.)

IS CLIENT INTERESTED IN PURCHASING A NEW PRODUCT REGIMEN TODAY?

WHAT TREATMENT IS CLIENT AGREEING TO GET TODAY?

LEFT PROFILE PHOTO (BEFORE TREATMENT)

RIGHT PROFILE PHOTO (BEFORE TREATMENT)

AERIAL VIEW PHOTO (BEFORE TREATMENT)

CHIN/NECK VIEW (BEFORE TREATMENT)

LEFT PROFILE PHOTO (AFTER TREATMENT)

RIGHT PROFILE PHOTO (AFTER TREATMENT)

AERIAL VIEW PHOTO (AFTER TREATMENT)

CHIN/NECK VIEW (AFTER TREATMENT)

View All Photos
POST - Treatment Notes

HOW WILL WE REMEMBER THIS CLIENT? WHAT DID YOU LEARN ABOUT THEM?

WHAT PRODUCTS DO YOU RECOMMEND FOR AT HOME USE?

ADDITIONAL NOTES

APPOINTMENT SUMMARY

View Entire History

IS THIS YOUR FIRST TIME RECEIVING A SERVICE AT FLESH?

no

HOW DID YOU HEAR ABOUT US?

ARE YOU PREGNANT OR BREASTFEEDING?

no

WHEN AND WHERE WAS YOUR LAST FACIAL SERVICE? WHAT TYPE OF SERVICE DID YOU RECEIVE? WERE YOU SATISFIED WITH YOUR RESULTS?

Flesh. Not sure what kind of facial

BIRTHDATE MM/DD/YY

2/2/1975

TELL US ABOUT YOUR CURRENT SKIN CARE REGIMEN. WHAT PRODUCTS DO YOU USE?

Purpose cleanser , c-vit serum, mandelac serum, c-vit radiance, Elta md sunscreen

ARE YOU CURRENTLY USING ANY PRODUCTS WITH RETINOLS, AHA/BHA. OR ANY OTHER ACID?

Yes

HOW OFTEN DO YOU USE THE PRODUCTS YOU LISTED ABOVE?

Every Morning and some nights

HAVE YOU SEEN A DERMATOLOGIST IN THE LAST SIX MONTHS? IF SO, WHY? WAS ANYTHING PRESCRIBED?

No

LIST ANY MEDICATIONS AND SUPPLEMENTS YOU ARE CURRENTLY TAKING AND HAVE TAKEN IN THE LAST SIX MONTHS.

High blood pressure, multivitamins

HAVE YOU EVER TAKEN ACCUTANE? IF SO, LIST ALL DATES AND LENGTH OF TIME.

No

PLEASE LIST ALL ALLERGIES.

None

DO YOU HAVE ANY RASHES, SKIN CONDITIONS, MEDICAL CONDITIONS, OR DISORDERS?

High blood pressure

WHAT TYPE OF DIET DO YOU FOLLOW?

I eat meat and dairy products

HOW OFTEN DO YOU MAKE BOWEL MOVEMENTS?

Few times a week

DO YOU SMOKE?

no

WHEN IS THE LAST TIME YOU DETOXED? WHAT TYPE OF DETOX DID YOU DO, AND FOR HOW LONG?

At least a year

WHAT ARE YOUR OVERALL SKIN CARE GOALS?

Decrease fine lines, even skin tone, and smooth texture

Intake Form

Product Purchases

bottom of page