Client Form | MiamiNaturalSkincare

Have you had a facial before?

Which of the following best describes your skin?

What temperature water do you use to cleanse with?

Do you use sunscreen on your face every day?

Do you exfoliate at home?

Have you used Retinoids (Retin-A, Retinol, Differin or other Vitamin A derivative products) in the last 3 days?

How frequently do you spend time in the sun?

Do you sunbathe or use tanning beds?

Do you use products containing hydroquinone?

Have you taken Accutane in the last 6 months?

Have you recently seen a dermatologist?

Are you taking/using anything prescribed by a dermatologist?

Have you had chemical peels, laser or microdermabrasion?

Have you had Botox, Restylane, Collagen or similar injections?

Do you smoke?

Do you wear contact lenses?

Are you allergic to any skincare or makeup ingredients?

Are you currently seeing a physician for a specific medical reason?

Do you have metal implants or a pacemaker?

Are you taking/using hormonal contraceptives/IUDs?

Are you pregnant or trying to become pregnant?

Are you breastfeeding?

Do you suffer from any hormonal issues, PMS, estrogen dominance, PCOS, high testosterone, or hormonal acne?

Are you peri-menopausal or in menopause?

Are you undergoing any hormone replacement therapy?

Miami Natural Skincare