Full Name: Dara Potts
Date of Birth: 1996-06-08
Email Address: darapotts96@gmail.com
Emergency Contact: Ethan Look, 6508238500
Medical History : Other, – n/a
Additional Details : n/a
Have you been under the care of a dermatologist within the past year? Yes, – general skin checks and treatment for acne
Are you taking any medications or dietary supplements? Yes, – spironolactone
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? n/a
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, Dry Skin, Aches / Pains, –
What is your current facial care routine? cleanser, vitamin C, hydrating syrum, moisturizer, spf
Facial concerns: Dull Skin, Breakouts / Acne, Dehydration, Redness, Wrinkles/Fine Lines, –
What is your current body care routine? moisturizer
Name : Dara Potts
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651675285.png
Enter Date : 2022-05-04
