top of page
9/3/21, 10:00 PM
Danaya

Matthew Jackson

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

Overview of Last Appointment

Date & Time

THIS IS THE CLIENT'S FIRST VISIT! LET'S MAKE IT ONE TO REMEBER! 

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:

03-Sep-21
View Today's Appointment Notes

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?

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?

BIRTHDATE MM/DD/YY

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

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

HOW OFTEN DO YOU USE THE PRODUCTS YOU LISTED ABOVE?

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

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

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

PLEASE LIST ALL ALLERGIES.

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

WHAT TYPE OF DIET DO YOU FOLLOW?

HOW OFTEN DO YOU MAKE BOWEL MOVEMENTS?

DO YOU SMOKE?

no

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

WHAT ARE YOUR OVERALL SKIN CARE GOALS?

Appointment History

Purifying
Danaya

VIEW ALL APPTS

bottom of page