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?
HOW DID YOU HEAR ABOUT US?
ARE YOU PREGNANT OR BREASTFEEDING?
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?
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?