Skin intake
form.

Before your first facial, tell us what your skin has been through. It's how we decide what your hour actually looks like, instead of guessing on the day.

About three minutes. Answer what you can — anything you skip, we'll cover in person during your consultation.

Leave this empty

You

Client name

Date of birth

Phone

So we can match this form to your booking.

Medical history

Does any of this apply to you?

Tick everything that applies. Several of these change which modalities are safe to use, so it matters more than it might seem.

Current medication

Including prescription actives — retinoids or tretinoin, isotretinoin (Accutane) in the last 12 months, antibiotics, blood thinners, anything that makes skin more sun-sensitive.

Treatments

Current treatments

Anything ongoing right now — a course of peels, laser, injectables, dermatology care.

Previous treatments

What you've had before, roughly when, and how your skin responded.

Products you're using

Morning and night. Brand names are fine — or bring a photo of the shelf on the day.

Your skin

Eating pattern and fluid intake

Roughly how you eat and how much water you drink in a day. Dehydration shows up in skin long before it shows up anywhere else.

Skin type, if you know it

Concerns you want to address

What's been frustrating you, what you've already tried, what you're hoping for.

Last thing

Everything above is accurate as far as I know, and I'll tell the team if anything changes before my appointment.

What you write here goes straight to our team and nowhere else. It is stored encrypted, it is never sold or shared, and it is not used for advertising. To have it deleted, email rubywei@ilmodobeauty.com and it will be deleted within 24 hours.

Thank you.

Skin intakeform.

Skin intake
form.