Facial Treatment Skin Evaluation Form

 

    Services & Prices

Spa Treatments

Facial Treatments

Massage Therapy

Men's Services

Teen Services

Consultation Analysis

 

Our goal is to customized your treament with the right products for your skin type, and pay special attention to any problem areas. Your consultant compiles valuable information through a evaluation form completed during your initial visit.

You can speed up this process by completing this evaluation form on line, or click here for a complete Confidential Personal History package in print version you can complete in the comfort of your home or office (Adobe Reader required--click here to download). Fax it, or bring it to your scheduled initial visit.

All information supplied is strictly confidential
.

Full name:

Email address:

Phone number
(with area code):

Address
Apt. or Suite
City
State Zip

  Skin Information
Skin Color & Condition
Choose one: healthy unhealthy
Skin Type
Existing Conditions
(select all that apply)
flaking blemishes peeling
blackheads whiteheads enlarged pores
  postule acne    
Facial hair
Muscle Tone (choose one)
Good Fair Fallen
When was your last facial treament?
Be specific about the type of service you received (ex. chemical peel)


Call 1-917-355-4506 for
an appointment at our new location!!

A 50% of the total service cost is required on all Spa services.

A 10% service charge is applied for cancellations.

24 hour notice is required when rescheduling or canceling any spa services, and 48 hour notice when rescheduling or canceling spa packages or spa group services. Credit card cash and Spa Finder’s Gift Certificates accepted.


Being on time is greatly appreciated, so you can receive
your full service and our guests are not inconvenienced.

homeservices & pricesspa facts & news productsresources contact the SPAgift certificates privacy policy consultation
Designed by EWR Corporate Communication © 2008-2009

Pure Skin Spa Hours: **Additional charge for special hours
Mon—Closed |Tues—9 am-7:30 pm |Weds—9 am-6 pm | Thurs—9am-7:30pm | Friday—10am-9pm |Sat—9am-6pm | Sunday—Closed