SARAH LASER MEDSPA
Skin | Laser
New Client Questionnaire & Medical History Form
In order to provide you with the most appropriate treatment, we need you to complete the following questionnaire. All information is strictly confidential. Please read the content below then scroll to the bottom of the form to sign.
Date: May 26, 2022
I certify that the preceding medical, personal skin history statements are true and accurate. I am aware that it is my responsibility to inform the technician, esthetician, therapist, doctor or nurse of my current medical or health conditions and to update this history. A current medical history is essential for the caregiver to execute appropriate treatment procedure.