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

SKIN CARE

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

ACKNOWLEDGEMENT & RELEASE

Thanks for submitting!

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