Skin Alchemy HITransforming Skin, Enhancing Lives

Skin Alchemy HI

Transforming Skin, Enhancing Lives

Client Health History Update Form

This form is required before every service and allows returning clients to update any changes to their health, lifestyle, or skincare routine since their last visit. Keeping this information current helps ensure each treatment remains safe, effective, and personalized.

Personal Information

First name *

Last name *

Email *

Phone

Today's Date *

Month

Day *

Year *

Modality Preferences

Which services from our FREE modality list are you most interested in?

I'll let my esthetician decide!

PDT / LED Therapy

Dermaplaning

Microdermabrasion

Extractions

HydroJelly / Modeling Mask

High Frequency

Facial Massage

Facial Reflexology

Facial Cupping

Facial Lymph Drainage

Carboxy Gel Treatment

Neck Treatment

Chest Treatment

Scalp Treatment

Treatment Mask

Ultrasonic

Hand & Arm Massage

Please note: While you may select up to 6 modalities, not all may fit into a single facial. We'll prioritize your top choices to create the most effective treatment for your skin.

Health History Update

Have you had any changes in your health since your last appointment? *

Yes

Signature

Signature *

By signing (drawing or typing your name), you confirm the information above is accurate.

Cancel and return to consultation forms

Skin Alchemy HI

Transforming Skin, Enhancing Lives

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