top of page
shutterstock_1084874669.jpg

Client Intake Form

Disclaimer:

Thank you for your interest in being a client of Studio Blu.  This form is used to collect information about new clients and used for internal purposes only.  The information you provide is confidential and will be treated accordingly.

Client Information

ALLERGIES & REACTIONS

WHAT IS YOUR SKIN TYPE?
WHAT AREAS OF CONCERN DO YOU HAVE REGARDING YOUR SKIN? (check all that apply)
WHEN YOU GO OUT INTO THE SUN, DO YOU:

SKIN CARE

HAVE YOU SEEN A DERMATOLOGIST WITHIN THE PAST YEAR?
DO YOU CURRENTLY USE ANY OF THE PRODUCTS LISTED BELOW? (check all that apply)
HAVE YOU RECENTLY RECEIVED BOTOX, RESTYLANE OR COLLAGEN INJECTIONS:

ACKNOWLEDGEMENT & RELEASE

Thanks for submitting!

bottom of page