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First name

Last name

CONTACT NUMBER

EMAIL ADDRESS

AGE

Which of the following services would you like a consultation for?

SKIN

    AESTHETICS

      BODY

        Which statement best reflects how you want to look & feel?




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        What is your present skin type?

        What do you like about your skin?

        What do you dislike about your skin?

        If you could enhance one aspect of your skin, what would it be?

        How often to do get a facial?

        Have you had a consultation or treatment for a cosmetic procedure before?

        What is your present skincare regime?

        Any allergies or allergic reactions we should be aware of?

        Are you pregnant?

        Have you had waxing, threading or peel services done in the past 72 hours?

        Thank you

        Our representative will contact you soon