Please review before submitting your consultation request
By submitting this intake form, you acknowledge and agree to the following:
1. Consultation Purpose
This virtual consultation is designed to provide professional skin analysis and personalized skincare guidance, including recommendations for at-home skincare routines and optional professional aesthetic treatments.
This service does not replace medical advice, diagnosis, or treatment from a physician or dermatologist.
2. Skincare & Treatment Recommendations
All recommendations are based on the information provided in your intake form and submitted images (if applicable).
You understand that:
- Skincare results vary by individual
- Products and protocols may need adjustment over time
- No specific outcome is guaranteed
- Consistency and proper use are essential for results
3. Professional Treatments (Optional)
If clinically appropriate, you may be presented with optional professional treatment suggestions
These services are optional and not required to follow your at-home protocol.
All in-person treatments (if pursued) are subject to separate consent forms and consultation at the time of service.
4. Product Use Disclaimer
Any skincare products recommended are for cosmetic use only and should be used as directed.
You agree to:
- Follow application instructions carefully
- Perform patch testing when advised
- Discontinue use if irritation occurs and notify us if needed
5. Medical & Skin History Disclosure
You confirm that all information provided in this intake form is true and complete to the best of your knowledge.
You agree to disclose any relevant skin conditions, allergies, medications, or recent procedures that may affect your skin response.
6. Client Verification & Safety
For safety and professional record-keeping purposes, identity verification may be required prior to consultation approval.
This helps ensure a secure and appropriate consultation environment for all clients.
7. Limitations of Service
This consultation provides educational and cosmetic skincare guidance only.
It does not:
- Diagnose medical skin conditions
- Prescribe prescription medication
- Replace in-person dermatological evaluation
8. Consent Agreement
By submitting this form, you confirm that:
✔ You understand the nature of this consultation
✔ You consent to receive personalized skincare recommendations
✔ You have read and agree to the Consultation Terms & Conditions
✔ You are voluntarily requesting this service
