Skin Care Treatment

If you are receiving a skin care treatment for the first time this year, please fill out this form and submit before your appointment.  Please fill in the portions relative to your services you are receiving in order to help us learn more about you and how we can make your experience the best it can be here at The Spa.

Spa Intake Form for Skin Care

Would you like to hear about promotions and specials?
Are you pregnant? *
Are you breastfeeding?
Active treatment or history of cancer *
Recent Surgeries (within the past 3 years) *
Skin Care Treatment
Are you currently prescribed medicine to care for your skin?
Do you currently apply Retinol products or Retin A to your skin?
Are you wearing contact lenses?
Do you apply any Glycolic products or any other exfoliating acids regularly at home?
Area's of Concern
Check if any currently apply to you