Client Record CardPlease enable JavaScript in your browser to complete this form.NameStreet AddressCityPostal CodeTelephoneE-mailDate of BirthWhat method of hair removal are you presently using?Have you ever experienced the Alexandria Professional treatment before?YesNoHave you experienced a severe skin reaction OR do you have a skin disorder?YesNoIf YES, please explain:Do you suffer from eczema or psoriasis?YesNoAre you presently taking any medication either orally or topically?YesNoIf YES, please explain:Do you use Retin-A, Retinol or Glycolic Acid in any skin treatment or do you receive any professional (dermatology) skin treatments?YesNoDo you use micro-dermabrasion techniques as a form of exfoliation:YesNoDo you consider your skin to be sensitive?YesNoDo you hydrate your skin regularly?YesNoDo you exfoliate your skin regularly?YesNoDo you detoxify your skin regularly?YesNoIf YES, with which products?Are you pregnant?YesNoIf YES, for how long?Are you experiencing any hormonal imbalance?YesNoIf YES, please explain:How did you hear about Sweet-Skin?EmailSubmit