Client form CLIENT'S INFORMATION Full name: Date of birth Language spoken - If you dont speak English, we will use Google Translate to communicate and assist you during your treatment English Croatian Other Address: City: ZIP code: E-Mail: Phone: EMERGENCY CONTACT Name: Relationship: Phone: MEDICAL INFORMATION Heart condition Cancer Migraines Diabetes High or low blood pressure Recent injectables (e.g., botox, fillers) Autoimmune diseases Epilepsy or seizures Asthma or respiratory issues Implants (e.g., Pacemaker, metal plates) Psoriasis or eczema Implants (e.g., Pacemaker, metal plates) Pregnant Breastfeeding Sensitive skin Allergies: Recent Surgeries: MEDICATIONS SKIN CONCERNS Dry Oily Combination Uneven skin tone Acne scarring Pigmentation Fine lines & wrinkles Enlarged pores Age spots Rosacea Acne/Breakouts Dark under-eye circles Other SKIN CARE HISTORY Morning Evening MASSAGE PREFERENCES Focus on this area Scalp/head Neck Shoulders Lower back Arms Legs Feet Avoid this area: Scalp/head Neck Shoulders Lower back Arms Legs Feet MASSAGE PRESSURE Firm is only suitable if purchased customised massage Light pressure Medium pressure Firm pressure CONSENT AND AGREEMENT I understand that the facial treatment is not a substitute for medical treatment or advice. I have provided accurate information to the best of my knowledge. I consent to the facial treatment and agree to follow the therapist's recommendations for aftercare and skincare. I consent to the use of advanced technology and devices (e.g., LED, ultrasound, hydrodermabrasion) during treatment if recommended. Your information is confidential and used only for treatment and safety purposes in line with EU GDPR regulations. We do not share your data with third parties. Send
