DISCOVERY QUESTIONAIRELet's get to know your goals, your skin, and how we can support your best self. Full Name * First Name Last Name Birthday (Month/Day) * Email * Phone * (###) ### #### Would you like to receive birthday promotions? * Yes No What is the main reason for your visit today? * Have you ever had a cosmetic consultation or treatment? Yes No If yes, what type(s)? When you look in the mirror, how do you feel you appear? Tired Sad Angry Dull Saggy Perfect Other How often do you think about cosmetic treatments? * Never Sometimes Often Frequently Areas you'd most like to improve * Skin Texture/Tone Volume Loss Body Shape Hair Health Fine Lines/Wrinkles Facial Contour Skin Firmness Other Ultimate aesthetic goal * Look more rested Appear more youthful Improve confidence Correct a concern Prevent aging signs Other Type out which of the following treatments that interest you * Skin: Acne Scars, Pigment (Red/Brown), Tighten, Resurface, Wrinkles, Pores, Medical Facial, Tattoo Removal Face: Facial Fillers, Wrinkle Relaxers, Youthful Eyes, Nasal Reshaping, Facial Feminization, Skin Tightening/Facelift Body: Skin Tightening, Fat Reduction, Contouring, Cellulite Hair: Laser Hair Removal How would you rate your skin's quality? * Poor Fair Good Excellent If you could improve one aspect of your skin * Hydration Elasticity Smoothness Pigmentation Clarity Firmness Other Current skincare routine includes * Nothing OTC skincare Medical-grade skincare At-home devices In-office treatments Commitment to improving appearance * Just curious Explore options Start now Long-term plan Preferred treatment types: * No downtime Immediate results Long-term benefits Natural-looking All of the above Are you preparing for an event? * Yes No If yes, when is the event?: How often are you open to treatment? One-time Every few months Monthly As part of a custom treatment plan How did you hear about us? Friend/Family Google Facebook Instagram Review Email Referral Other Open to receiving * Education Offers VIP Invites Interested in membership/custom plan? * Yes No Learn more Thank you!
