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)
INTAKE FORM RESPONSES
IS THIS YOUR FIRST TIME RECEIVING A SERVICE AT FLESH?
yes
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?
i received a deep pore cleaning, microdermabrasion, and jelly mask at she’s stunning boutique. initially there was a glow to my skin then i saw very big pimples afterwards
BIRTHDATE MM/DD/YY
11/4/1996
TELL US ABOUT YOUR CURRENT SKIN CARE REGIMEN. WHAT PRODUCTS DO YOU USE?
I use the Cerave foaming cleanser, and daily moisturizer morning and night. and i use curology: azelaic acid 4%, niacinamide 4%, clindamycin 2% every night and thayers witch hazel with rose water every morning and night
ARE YOU CURRENTLY USING ANY PRODUCTS WITH RETINOLS, AHA/BHA. OR ANY OTHER ACID?
azelaic acid, niacinamide, clindamycin
HOW OFTEN DO YOU USE THE PRODUCTS YOU LISTED ABOVE?
Every morning & night- I never forget!
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.
probiotics, vitamin c, chlorophyll drops
HAVE YOU EVER TAKEN ACCUTANE? IF SO, LIST ALL DATES AND LENGTH OF TIME.
no
PLEASE LIST ALL ALLERGIES.
per dander
DO YOU HAVE ANY RASHES, SKIN CONDITIONS, MEDICAL CONDITIONS, OR DISORDERS?
i had eczema when i was younger but it has cleared up on its own
WHAT TYPE OF DIET DO YOU FOLLOW?
I eat meat and dairy products
HOW OFTEN DO YOU MAKE BOWEL MOVEMENTS?
At least once a day
DO YOU SMOKE?
no
WHEN IS THE LAST TIME YOU DETOXED? WHAT TYPE OF DETOX DID YOU DO, AND FOR HOW LONG?
n/a
WHAT ARE YOUR OVERALL SKIN CARE GOALS?
healthy, smooth even toned skin, no acne break outs or hyper pigmentation