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12/10/21, 4:30 PM
Danaya

Indy Bell

This is the client's first visit in over a year! 

Overview of Last Appointment

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:

10-Dec-2021

PRE - Treatment Notes
Upload BEFORE Photos
Input Notes for RETURNING Clients
Input Notes for NEW Clients
POST - Treatment Notes
Upload AFTER Photos
Input POST-Treatment Notes
Log Purchases

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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Appointment History

Danaya
Jewel
Jewel

VIEW ALL APPTS

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