New Client Questionnaire

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Name*

First Last

Email*

Cell Phone Number*

Birthdate*

Address

Street Address Street Address Line 2 City State / Province ZIP / Postal Code

Gender

Is this your first facial? Or when did you have your last facial?

Is this the first time you have been waxed? What is the approximate date of getting waxed? OR What is the approximate date of last time you shaved?

Do you have a big event coming up? If so, what is the event? (such as Wedding, Vacation, getting a new Tattoo, Graduation, New Job, Big Celebration). What is the date of the event?

What oral medications are you currently taking?*

Please check if you are using any of the following?*

Have you ever had Fever blisters, cold sores, or Herpes? If so, when was your last breakout?

Do you have eczema? or psoriasis? If so, what is the body part location? What are the medications you take/use to manage it?

Have you ever had any reaction to any products or anything you have put on your face?

Please list any plants, vegetables, fruits or herbs that you have experienced an allergic reaction?

Please list anything you are allergic to (such as sulfur, aspirin, latex, or other):

Do you smoke or vape? Yes? or No?

Do you use Fabric Softener? or Dryer Sheets in the dryer?

Do you frequently swim in a chlorinated pool? If yes, how many days a week?

Do you work around chemicals, tars, oils, grease or inks?

What is your occupation? and do you work nights?

Are you currently under a lot of stress? (such as job loss, new job, wedding, romantic breakup, death in the family or close friend, graduation, difficult home life, long commute, heavily scheduled)

For Women Only: Do you use birth control pills, shots, or IUD? If yes, what is the brand name of birth control? for men, write N/A

Are you in menopause? or Perimenopause?

For Men Only: Do you have shaving irritation? What products do you use for shaving? For Women, write N/A

Foods - Do you consume the following?

Please list the treatments and date of treatment that you have done for your skin in the last 90 days? such as Microblading, Microneedling, Chemical Peels, Microdermabrasion, Laser Hair Removal, Laser treatments, Skin Cancer Removal, Face Waxing, Dermaplaning, Electrolysis, Botox, Fillers, Cosmetic Surgery? Mohs surgery?

Which skin conditions do you want to improve? ie: Hyperpigmentation (dark spots), Acne scars, Melasma, Enlarged pores, Sun Damage, Fine Lines and Wrinkles, Acne breakouts, hormonal acne, dryness, dehydration

Products you are currently using - please write Brand and Product Name because many brands have multiple types of cleansers. For example, Aveeno has 11 cleansers.

Brand name & Product name of Cleanser, Face Wash or Soap*

Brand name & Product name Toner or Essence*

Brand name & Product name of lotion, cream, or Moisturizers*

Brand name & Product name of oils and Serums*

Brand name & Product name of Eye serum and/or Eye Cream*

Brand name & Product name of sunscreen with SPF*

Brand name & Product name of Masks*

Brand name & product name of Foundation Powder, Liquid, and/or Concealer*

Brand name & product name of Acne Medications*

Who should I thank for referring you to me? Please list their first & last name.

What social media platform or search engine did you find me on?

Appointment and Cancellation Policies

For Lisa Nadler Skin Care and Waxing

PLEASE READ CAREFULLY:

We require a 48 hour notice for cancellations. We will charge the FULL AMOUNT of the service(s) booked for cancellations in less than 48 hours or for no showing to the appointment. Arriving late will limit the time for your treatment, lessening the effectiveness and your pleasure. You will be charged for the full amount as scheduled for your treatment and it will end at the scheduled time so that the next client will not be delayed.

If you have a membership or package, your missed appointment will count as fulfilled. If we do charge you for the missed appointment, it is not intended as a punishment; it is part of your agreement with us as it allows us to serve ALL clients.

Unexpected events like illness, work/personal emergencies and travel delays are NOT EXEMPT from our cancellation policy.

For Facial and Acne Clients: Please make sure you are off of ALL Oral acne prescriptions and topical acne perscription meds for 14 days prior to your scheduled appointments. This includes but is not limited to Retin-A (even if you only use it once or twice a week), Accutane (need to be off 6 months), Doxycycline, Benzoyl Peroxide, Epiduo, Differin, Tri-Luma, Hydroquinone, Isotretinoin. If you have had any Botox or Fillers you must wait a full 14 days post injection for any facial service.

For Waxing Clients: You must have 3 weeks of not shaving to allow for enough hair growth at the time of your appointment. It is optimal to have 1/4 inch to 1/2 inch hair growth. If you schedule a service and your hair is too short to wax, you will be charged the full amount of the service booked. Please bring ID to your appointment to confirm you are at least 18 years old or please bring your parent/guardian to sign waxing permission slip.

By clicking submit, you are agreeing that you understand our cancellation policy, treatment and waxing policies.

Name

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