Full Name: Luke Michalak
Date of Birth: 1996-08-30
Email Address: email@example.com
Emergency Contact: Matt Michalak
Medical History : Headaches / Migraines, –
Additional Details : N/A
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? 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? ,
Body Concerns:Muscular Tension, Stress, Energy levels, –
What is your current facial care routine?
Facial concerns: Blackheads/Whiteheads, Dehydration, Redness, –
What is your current body care routine?
Name : Luke Michalak
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651338642.png
Enter Date : 2022-04-30