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Facial Client Consent & Liability Release Form

Thank You for choosing InkySPA Studio LLC to help get your skin glowing again. Please fill out this consent form so that we can better assist your skin care needs.

Birthday
Month
Day
Year
Gender
Multi-line address
What type of skin do you have?
Normal
Oily
Combination
Acne
Not Sure
Have you had any facial or dermatology services in the past 30 days?
Have you been under the care of a dermatologist within the past year?
Have you used Retin-A, Renova, AHAs or Retinal/Vitamin A products in the last three months?
Have you received Botox, Restylane, or Collagen injections in the last 6 months?
Skin Care History Check the products that you currently use (please select all that apply):
What concerns do you have regarding your skin? Please select all that apply:
Are you currently taking any medications?
Medical History
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By signing, I agree to all of the following mentioned above

Date
Month
Day
Year

Thank You! Please give us some time to review your form. Questions or Concerns Text 708-401-7599. We are looking forward to you appointment at InkySPA Studio LLC

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