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Client Consultation

Birthday
Day
Month
Year
Are you prone to any of the following?
Please tick the box; are you or do you have any of the following -
Do you or have you had any of the following?
Have you been treated with any of the following?
Please Indicate if you are having or have had any of the following -
Tell me what are you main concerns?
Tell me more about your skin care and make-up routine -
How do your cheeks look and feel?
How does your T Zone look and feel?
How does your eye area look and feel?
Describe the environment that your skin lives in
What kind of sun exposure do you get?
On average how many hours of sleep to you get a night?
Per Day, please indicate if any of the following are included-
Per Week, please indicate if any of the following are included-
Are you any of the following?

To the best of my knowledge the medical information is relevant and factually correct. By Signing below i am consenting to Fiona Weston Skin Health to store and process my personal and medical information.

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