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)
Today's Session:
11-May-21
PRE - Treatment Notes
POST - Treatment Notes
INTAKE FORM RESPONSES
IS THIS YOUR FIRST TIME RECEIVING A SERVICE AT FLESH?
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HOW DID YOU HEAR ABOUT US?
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ARE YOU PREGNANT OR BREASTFEEDING?
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WHEN AND WHERE WAS YOUR LAST FACIAL SERVICE? WHAT TYPE OF SERVICE DID YOU RECEIVE? WERE YOU SATISFIED WITH YOUR RESULTS?
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BIRTHDATE MM/DD/YY
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TELL US ABOUT YOUR CURRENT SKIN CARE REGIMEN. WHAT PRODUCTS DO YOU USE?
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ARE YOU CURRENTLY USING ANY PRODUCTS WITH RETINOLS, AHA/BHA. OR ANY OTHER ACID?
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HOW OFTEN DO YOU USE THE PRODUCTS YOU LISTED ABOVE?
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HAVE YOU SEEN A DERMATOLOGIST IN THE LAST SIX MONTHS? IF SO, WHY? WAS ANYTHING PRESCRIBED?
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LIST ANY MEDICATIONS AND SUPPLEMENTS YOU ARE CURRENTLY TAKING AND HAVE TAKEN IN THE LAST SIX MONTHS.
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HAVE YOU EVER TAKEN ACCUTANE? IF SO, LIST ALL DATES AND LENGTH OF TIME.
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PLEASE LIST ALL ALLERGIES.
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DO YOU HAVE ANY RASHES, SKIN CONDITIONS, MEDICAL CONDITIONS, OR DISORDERS?
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WHAT TYPE OF DIET DO YOU FOLLOW?
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HOW OFTEN DO YOU MAKE BOWEL MOVEMENTS?
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DO YOU SMOKE?
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WHEN IS THE LAST TIME YOU DETOXED? WHAT TYPE OF DETOX DID YOU DO, AND FOR HOW LONG?
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WHAT ARE YOUR OVERALL SKIN CARE GOALS?
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