Waiting ListSkincare Membership Questionnaire Name * First Name Last Name Email * Phone * (###) ### #### Have you been here previously for any skincare needs? * YES NO Skincare Goals * Healthy Glowing Skin Even Skin Tone Clear Acne Tighter Skin Have you ever had a chemical peel * NO YES Do you have a history of epilepsy or do you have photo light sensitivity? * Yes NO Are you allergic to lidocaine or any other numbing cream? * YES NO List specific skin issues and known allergies. Thank you, we will email you when our membership opens
