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Total Body Care Skin Consultation Form
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Morning Regime
Weekly Treatments
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Your Treatment Goals
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What would you like from this visit?
Product to take home
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Favorite Treatments
Body Care
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Treatment Length and Detail
Express (Clinical) 30 - 50 minutes
Pampered 60 - 75 minutes
Make up Foundation Coverage
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GREATEST MAKE UP CHALLENGE
Eye Shadow
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DESIRED MAKE UP LOOK
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SKIN TYPE
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Dry Skin
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PLEASE SELECT CONCERNS
Flakiness / Dry Skin: Face or Body
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Enlarged Pores
Clogged Pores
Excess Oil
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Blackheads face or back
Breakouts: face , back or bikini Line
Pigmented spots
Aging skin
Redness
Visible Capillaries
Muscle Tension, Soreness or Weakness
Hand / Nail Condition (roughness, dryness, hangnail)
Foot / Nail Condition (cracked, calloused, thickened)
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