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Facial Client Information Form

Facial forms are required for all facials regardless of the facial you are requesting as the form is good one year. If you are a new facial client or a client who has not had a facial within the past year then please fill out the forms prior to your visit. If you wish to fill out a copy at the spa, we request that you arrive 15 minutes before your appointment time.

Personal Information

Birthday
Month
Day
Year

Tell Us About Your Skin

What is your skin type?
What are your skin concerns?

Select all that apply

Have you ever experienced any of the following?

Select all that apply

If yes, where:
If yes, when:
When exposed to sun, you:
What skincare products are you currently using at home?

Select all that apply

Do any of your products contain any of the following?

Select all that apply

Are you currently using any of the following prescription products?

Select all that apply

Tell Us About Your Wellness

Check all of the following that are applicable for you:
Have you ever had a reaction or are you allergic to any of the following?

Select all that apply

Within the last year, have you been under the care of or had:

Select all that apply

In the last 14 days, have you had any of the following?

Select all that apply

Are you:

Select all that apply

I have acknowledged that all the information provided by me is true and correct to the best of my knowledge. I understand that some skin conditions may require more than one treatment and homecare products to achieve the desired result. Results cannot be guaranteed due to individual skin type(s) and condition(s).  

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CONTACT US

ADDRESS

OPENING HOURS

1701 Tullamore Ave. Suite C

Bloomington, IL 61704

CONTACT US

(309) 662-7727

ContoursDaySpa@gmail.com

Monday: 9am - 7pm

Tuesday: Closed

Wednesday: 9am - 7pm

Thursday: 9am - 7pm

Friday: 9am - 4pm

Saturday: 9am - 2pm

Sunday: Closed

Contact us

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