Medical Info Full name Email Phone number Place of birth Date of birth Age Reason for consultation How would you rate your skin type? Normal Oily Dry Mixed I don't know Skin Problems (If any) Spots on the skin Acne Wrinkles Sensitivity Rosacea Others If you select "Other", specify Do you have any aesthetic concerns? Have you had previous facial procedures? Yes No Do you use facial care products at home? Do you have a known allergy to facial care products or ingredients or any type of food? Do you have any restrictions or medical conditions that should be considered during facial procedures? Are you pregnant or breastfeeding? Yes No How would you rate your overall satisfaction with your current facial appearance? (From 1 to 10, with 1 being very dissatisfied and 10 being very satisfied) Additional comments or questions Send Covid-19 Health Declaration Name Last Name Email My body temperature is lower than 98.6°F / 37.5°C I am not experiencing the symptoms: fever, cough, sore throat, shortness of breath. I haven´t been in close contact with a covid-19 patient in the last 14 days. Initials Date I declare that the info I´ve provided is accurate & complete Submit Your moment is now, don't wait any longer and contact us! Make an appointment Book now Contact Us