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Client Intake Form

Please complete this form prior to your appointment at AKAYSKIN.

Medical Information
Medications
Have you received neuromodulators or filler in the last two weeks?
Are you pregnant or lactating?
Skin Concerns
Massage Preferences
Consent to before/after photos for client records
Consent to be posted on @akayskin social media

I have completed this form to the best of my ability/knowledge and agree to inform my aesthetician of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my aesthetician of any discomfort I may experience during my treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my aesthetician for any injuries or damages incurred due to any misrepresentation of my health history.

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