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Pre/Post Treatment
Facial
Contact

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Available days, evenings and occasional Saturdays

Home
About
Services
Pre/Post Treatment
Facial
Contact

Client Record Card

Name

Street Address

City

Postal Code

Telephone

E-mail

Date of Birth

What method of hair removal are you presently using?

Have you ever experienced the Alexandria Professional treatment before?

Yes
No

Have you experienced a severe skin reaction OR do you have a skin disorder?

Yes
No

If YES, please explain:

Do you suffer from eczema or psoriasis?

Yes
No

Are you presently taking any medication either orally or topically?

Yes
No

If 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?

Yes
No

Do you use micro-dermabrasion techniques as a form of exfoliation:

Yes
No

Do you consider your skin to be sensitive?

Yes
No

Do you hydrate your skin regularly?

Yes
No

Do you exfoliate your skin regularly?

Yes
No

Do you detoxify your skin regularly?

Yes
No

If YES, with which products?

Are you pregnant?

Yes
No

If YES, for how long?

Are you experiencing any hormonal imbalance?

Yes
No

If YES, please explain:

How did you hear about Sweet-Skin?

Email

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