E past year? O No O Yes Have you had any of these health conditions in the past or present? (Please check all that apply and provide additional information in the space provided) 0 Cancer 0 Arthritis 0 Immune disorders 0 Hormone imbalance 0 Asthma 0 HIV/AIDS 0 Systemic disease 0 Eczema 0 Lupus 0 High blood pressure 0 Epilepsy 0 Metal bone pins or plates 0 Spinal injury 0 Seizure disorder 0 Phlebitis/blood clots 0 Thyroid condition 0 Headaches (chronic) 0 Blood clotting abnormali.
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How to fill out the CA Katie Hartman Client Intake Form - Facial online
This guide will assist you in completing the CA Katie Hartman Client Intake Form - Facial online. By following these clear instructions, you can ensure that all necessary information is accurately provided to facilitate your skincare needs.
Follow the steps to efficiently complete the form online.
- Press the ‘Get Form’ button to obtain the client intake form and open it in your preferred document editor.
- Begin by entering your personal details in the first section. This includes your name, date, address, city, state, home number, date of birth, zip code, and email address.
- In the health history section, answer whether you have been under the care of a physician or other medical professional within the past year by selecting ‘Yes’ or ‘No’.
- Check any health conditions you have had in the past or are currently experiencing from the provided list. You are encouraged to provide additional details in the space provided.
- List any medications or vitamins you take regularly, ensuring to include all pertinent information.
- Indicate whether you use , , Hydroxyl Acid, Deferin, Glycolic Acid, Salicylic Acid, or Retinol, by selecting ‘Yes’ or ‘No’. If applicable, please describe.
- Respond to the questions regarding your sun exposure and sunscreen usage, selecting ‘Yes’ or ‘No’ accordingly.
- Note any adverse reactions you have experienced after using skin care products by checking the appropriate boxes.
- List any allergies you may have, ensuring to include the specific substances.
- Indicate if you are pregnant or trying to become pregnant, and whether you are currently nursing.
- Check any previous cosmetic procedures you have undergone from the listed options.
- Describe your skin type by selecting the option that aligns with your skin condition among the provided descriptions.
- Mark your specific skin concerns related to the facial treatment.
- Indicate your preferred pressure level for massages by selecting light, medium, or firm.
- Rate the focus areas for your facial today on a scale from 0 to 5, with 5 being the most important.
- Lastly, read and agree to the terms at the end of the form. Provide your electronic signature and the date to confirm that all information provided is truthful.
- Save changes, then download, print, or share the completed form as needed.
Take the first step towards your personalized skincare treatment by completing the CA Katie Hartman Client Intake Form - Facial online.
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