Acne Bootcamp Consultation Form

This form will be used to help gather relevant information regarding your skin and lifestyle habits. This will play a crucial role in developing your custom treatment plan and a successful introduction into acne bootcamp.

Your Skin Care

Please enter your current skin care products and usage to the best of your knowledge. Ex. Cleanser - Cleansing Complex - Daily AM/PM Exfoliator - Active Serum - 3x a week PM

More About You

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received.

The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.

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