General Skin Goals General Skin Goals Achieve a clear complexion Improve overall skin tone Enhance skin texture Boost hydration levels Minimize the appearance of pores Achieve a youthful glow Maintain skin elasticity

Hyperpigmentation: Hyperpigmentation: Even out skin tone Reduce dark spots and discoloration Brighten overall complexion

Redness: Redness: Soothe irritation and redness Minimize visible blood vessels Improve skin barrier to reduce sensitivity

Loss of Elasticity: Loss of Elasticity: Improve skin firmness and tightness Promote collagen and elastin production Use products that enhance skin structure

Fine Lines and Wrinkles: Fine Lines and Wrinkles: Reduce the appearance of fine lines Diminish deeper wrinkles Promote smoother skin texture

Scarring: Scarring: Minimize the appearance of acne scars Fade surgical or injury scars Improve skin texture in scarred areas

Dullness: Dullness: Revitalize tired, lackluster skin Enhance skin radiance and brightness Incorporate exfoliation into the routine

Dryness and Thinning Skin: Dryness and Thinning Skin: Restore moisture and hydration Improve skin barrier function Prevent skin from becoming too thin or fragile

Uneven Texture: Uneven Texture: Smooth rough patches Improve skin surface for a more polished look Address textural irregularities from aging

Would you be interested in any of the following new laser services (see checklist)? Would you be interested in any of the following new laser services (see checklist)? Yes No

If yes, please check all that apply: If yes, please check all that apply: Laser hair removal Treatment for spider veins Skin tightening and brightening Removal of cherry angiomas Active acne treatments Scarring treatments Other:

Other laser treatment.

Are you interested in more information regarding our weightloss management programs? Are you interested in more information regarding our weightloss management programs? Yes No

Are you interested in IM injections for wellness? Are you interested in IM injections for wellness? Yes No

Do you have any concerns or questions about the injection process, or what we offer? Do you have any concerns or questions about the injection process, or what we offer? Yes No

Concern or Questions

Are there any areas of your body are you looking to contour or reshape? Are there any areas of your body are you looking to contour or reshape? Yes No

Would you like information regarding options and expectations for body contouring treatments? Would you like information regarding options and expectations for body contouring treatments? Yes No

Are you experiencing any specific areas of pain or discomfort that you would like addressed by massage therapy? Are you experiencing any specific areas of pain or discomfort that you would like addressed by massage therapy? Yes No

What sports or activities do you participate in regularly?

Are you experiencing any specific injuries or recovery challenges? Are you experiencing any specific injuries or recovery challenges? Yes No

How can we support your recovery process? (e.g., massage therapy, red light therapy)

Is there anything else you would like us to know about your wellness goals or concerns?

Do you have any feedback regarding how we can we tailor our services to better meet your needs?

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