Skin Assessment Survey

Help us get to know you and your skin better before you come in for your appointment. By completing our pre-consultation survey, we could identify your skin type and needs, while your information can also help us create and customize a treatment and/or plan that best serves you in reaching your ideal skincare goals. Please complete your contact information, all the questions with the best of your knowledge and the name of the person that referred you! Thank you!

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* 1. Skin Assessment Form

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* 2. What brings you to Nouvellesthetics for a facial treatment?

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* 3. What are your ideal goals for your skin?

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* 4. Are you allergic to any ingredients or topical substances? Are you currently taking any medications for your skin that are prescribed by a physician? Such as accutane or prescription retinol?

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* 5. Help us identify your skin type and needs. Which of the following best describes how your skin feels throughout the day. What are your skin concerns?

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* 6. What skin care products are you currently using? Please list each product and brand to your best ability. How is it working for you? Does it help you reach your goals?

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* 7. How is your daily activity level like? How often do you work out? What are some other ways that you practice self-care? 

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* 8. Are you pregnant or nursing? If so, are you interested in receiving a Pre-natal Facial or would you like to learn about which treatment is safe while pregnant or nursing?

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* 9. How did you hear about Nouvellesthetics? Referral and new clients get 10% off. (May not be combined with other promotions, specials and discounts. 

For YOUR SAFETY be prepared to reschedule your facial treatment if you are using the following or have:
-Retin-A, Renova or any topical Retinoid Rx
-Currently taking Accurate
-Used microdermabrasion less than 7 days prior
-Had any facial waxing done in less than 24 hours prior to your appointment

IMPORTANT: For safe practices, please cancel/reschedule your treatment if you have symptoms of a cold/flu, any cuts, abrasions or active cold sores within 24-72 hours prior to your treatment.

Thank you for choosing Nouvellesthetics for your skin care needs.
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