Full Name: Melissa Merchant
Date of Birth: 1973-01-05
Email Address: mmerch73@gmail.com
Emergency Contact: Liz Roithmayr 908-514-6028
Medical History : Other, – Nothing
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? 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? Yes,
Body Concerns:Stress, Dry Skin, Cellulite, –
What is your current facial care routine? Rodan and Fields
Facial concerns: Aging, Blackheads/Whiteheads, Dehydration, Redness, Wrinkles/Fine Lines, –
What is your current body care routine? Noting
Name : Melissa Merchant
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651756320.png
Enter Date : 2022-05-05
