Full Name: Fatima Issa
Date of Birth: 1994-03-04
Email Address: fissa76@gmail.com
Emergency Contact: 5088402208
Medical History : Other, – None
Additional Details :
Have you been under the care of a dermatologist within the past year? No, –
Are you taking any medications or dietary supplements? No, –
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? Yes, – Regular contacts
Is there anything that may be important for us to know? None
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:Other (please specify), – None
What is your current facial care routine? Vitamin c cleansing, hyperpigmentation moisturizer
Facial concerns: Blackheads/Whiteheads, Pigmentation, Uneven skin tone, –
What is your current body care routine? Shea butter moisturizer
Name : Fatima Issa
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651496825.png
Enter Date : 2022-05-02
