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Client Card

Please enter your accurate personal details for our client records.

First Name*

Surname*

Date of Birth*

Gender

Ethnicity

Preferred Appointment Date*

Address

Postcode

Mobile*

Email*

Skin & Treatment Priorities

What are your main skin priorities? (If there was anything you could improve about your skin, what would it be?)

Are there any particular areas of the face / body you would like to focus on today?

What is your treatment timeline expectation? (E.g., do you have any special events coming up?)

Skincare Routine

Your current skincare routine & products currently using:

Previous Treatments (If yes, state when)

Details / When performed:

Hormone Conditions & Medications

Thyroid conditionPCOSHormone Replacement therapy

Regular Medications (antibiotics, antidepressants, etc.):

What medications, vitamins or supplements do you take on a regular basis?

Health & Medical Questions

Do you have any allergies? (Environmental or topical skin products):

Have you had any serious health problem / major surgery within the last 12 months?

Taking oral contraceptivesGoing through menopausePregnant / planning / lactatingUsing prescription skin medicationHistory of keloid scarring

How did you hear about us?