Client Intake Form

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Home
About
- My Work
- Testimonials
Promo
- Mother’s Day Promo 2024
Services
Shop
Blog
Forms
Contact

Client Intake Form

Must be Completed 48 hours prior to Appointment

Dear valued client,

We are excited to welcome you to our beauty and skincare center. To ensure that you receive the best and safest treatment possible, we kindly request that you provide us with some essential information. Your privacy and comfort are our utmost priorities, and this information will be kept confidential.

Preferred Contact Method

Phone Email Text

Emergency Full Name

Emergency Email

Emergency Phone Number

1). Medical History: Please inform us of any medical conditions, allergies, or medications you are currently taking, even if they may not seem relevant to your treatment. Your safety is important to us.

Yes None

Medical Conditions:

Yes None

Allergies:

Have you had any recent surgeries, including plastic surgery, cosmetic piercings, or tattoos on the face? If yes, please provide details. Additionally, have there been any restrictions advised by your doctor that we should be aware of? If yes, please explain. Your safety and comfort are important to us.

Yes No

Have you had any skin cancer? If Yes, Please explain. If you have answered "Yes," please provide more details:

Yes No

Are you taking medications that will affect your treatment ?:

Yes No

2).Skin History: Help us understand your skin better by providing details about your skincare routine and any previous treatments.

Yes None

Current Skincare Routine:

Yes None

Previous Facial or Skincare Treatments:

Yes None

Any Known Skin Sensitivities:

Yes None

3).Treatment Preferences: Let us know your preferences and goals for the treatment.

Desired Treatment:

Areas of Concern:

Goals for the Treatment:

Any products you currently use for your face / body?

Consent and Agreement: I hereby acknowledge that I have provided accurate and truthful information to the best of my knowledge. I understand that the esthetician will use this information to tailor the treatment to my needs and ensure my safety. By signing below, I confirm that I grant San Francisco Esthetics permission to administer treatment based on the information I have provided. I understand that the accuracy and truthfulness of the information I have given are vital for tailoring the treatment to my specific requirements and ensuring my safety. I acknowledge that I am responsible for providing accurate details and that any undisclosed information could impact the effectiveness and safety of the treatment.

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Hours

Monday: Closed
Tuesday: Closed
Wednesday: Closed
Thursday: 10:00AM-5:30PM
Friday: 10:00AM-5:30PM
Saturday: 10:00AM-5:30PM
Sunday: Closed
Call or Text * +1 (415) 309-8925

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San Francisco Esthetics
126 Serramonte Center Studio 12 Daly City, CA 94015

Phone: +1 (415) 309-8925

Email: info@sanfranciscoesthetics.com

Cancellation Policy
Privacy Policy
Returns and Refunds

Cancellation Policy
Privacy Policy
Returns and Refunds

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