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Treatment: £80

How would you describe your skin in general?

NormalOilyCombinationDrySensitiveCongestedDehydratedAcne-proneExtremely dry/flakyBlackheadsRosaceaOther

If you selected 'other,' please specify:

Is there a specific skin concern you would like us to focus on?

Acne/blemishesDry SkinDark spots or uneven skin toneWrinkles/fine lines/loss of firmnessClogged poresRednessRosaceaDull/tired skinOther

If you selected 'other,' please specify:

To promote healthy skin, extractions may be included in your treatment or recommended, if appropriate. Are you comfortable with your therapist performing extractions?

YesNo

Will you be wearing any of the following during your treatment?

Semi permanent eyebrowsContact lensesFalse eyelashes or lash extensions

Do you have any medical conditions?

Have you had any surgery or cosmetic procedures recently, such as Botox, chemical peels, injections, face lifts, thread lifts, Profhilo, Sculptra, peels, or dental services?

YesNo

yes, please specify.

Are you pregnant or breast feeding?

PregnantBreastfeedingNo

Are you taking medication (tablets, blood thinners, creams, ointments, injections, pessaries, hormone replacements, birth control, steroids etc.) If yes, please list them.

Do you suffer from Claustrophobia?

YesNo

Are you or do you have any of the following:

Pacemaker or Cardiac defibrillatorEpilepsyAcute or chronic skin diseasesBlood disorders ( HIV or Hepatitis)Open wound or blisters on skin surfaceDiabetesMetal plates or dental bridge work, pins or screwsHigh blood pressureKeloidsBruise easilyThyroid disorderEczemaPsoriasisrColdsores

Certain treatments or steps in our procedures may not be suitable if you have any of the following conditions.
Please indicate if any of these apply to you.

Autoimmune diseaseCancerNone

What kind of skincare products are you currently using in your skincare routine?

MistCleanserPeel/ExfoliatorMaskEssence/TonicSerumEye CreamMoisturiserFace OilSPFOther

If you selected 'other,' please specify:

Would you like the therapist to talk through the stages of treatment, or would you prefer a quiet spa session?

Quiet spa sessionTalk through the stages of treatmentNo Thanks

How do you want your skin to feel and look after this treatment?

GlowingLifted and sculptedClearEnergisedHealthyAll of the above

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