Virtual Spa Client Intake

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Virtual Spa Intake Form

Please complete this form so your Virtual Spa session can be fully personalized to your skin, goals, and comfort.

Your Information

Client Details

First name

Last name

Phone

Birthday

Month

Day

Year

Your Skin Profile

How would you describe your skin type?

What are your top skin concerns? (Select all that apply)

Acne / Breakouts

Texture

Fine Lines / Wrinkles

Redness / Sensitivity

Dark Spots / Pigmentation

Dryness / Dehydration

Oiliness

Aging Prevention

Other

Tell me about your current skincare routine.

Do you have any known allergies or sensitivities?

Lifestyle & Wellness

How much water do you typically drink each day?

Less than 16 oz

16–32 oz

32–64 oz

64–80 oz

80+ oz

How would you describe your sleep quality?

How would you describe your current stress level?

Are you currently taking any medications or managing any health conditions that may affect your skin?

Safety & Contraindications

Are you currently pregnant or breastfeeding?

Yes

Prefer Not to Say

Have you had any recent skincare treatments or procedures? If yes, please list them.

Have you experienced any recent skin irritation, reactions, or flare‑ups?

Do you consent to a virtual patch‑test recommendation if needed?

Yes

Final Confirmation

I confirm that the information I’ve provided is accurate to the best of my knowledge.

I understand that this Virtual Spa session provides professional skincare guidance and is not a medical service.

I consent to proceed with my Virtual Spa session based on the information I’ve provided.

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