Full Name: Adeline Pierre
Date of Birth: 1985-09-08
Email Address: adelinepierre28@gmail.com
Emergency Contact: 6493416627
Medical History : Other, – C section only
Additional Details : None
Have you been under the care of a dermatologist within the past year? No, –
Are you taking any medications or dietary supplements? Yes, – Family planning
Have you had any surgery in the last 12 months? No, –
Have you received Botox, Restylane, Collagen or any other injections in the last 6 months? No, –
Do you wear contact lenses? No, –
Is there anything that may be important for us to know?
For ladies: Are you pregnant, planning a pregnancy, breastfeeding, using birth control or menstruating? Array
For ladies: Are you taking birth control pills? No,
Body Concerns:Muscular Tension, Aches / Pains, –
What is your current facial care routine? Moisturizer, face mask
Facial concerns: Uneven skin tone, –
What is your current body care routine?
Name : Adeline Pierre
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651942656.png
Enter Date : 2022-05-07
