Full Name: Shona McKenna
Date of Birth: 1974-03-14
Email Address: firstname.lastname@example.org
Emergency Contact: Marian McKenna
Medical History : Fillings / Cavities, Allergies / sensitivities, –
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, – Soft, daily disposable contacts
Is there anything that may be important for us to know? I have a benign heart murmur. I am allergic to penecillin and bee stings.
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, –
What is your current facial care routine? Wash, tone, moisturise.
Facial concerns: Aging, Blackheads/Whiteheads, Breakouts / Acne, –
What is your current body care routine?
Name : Shona McKenna
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651336172.png
Enter Date : 2022-04-30