Client Information Update Form Client Information Update Form Name * Name First First Last Last Have any of the following changed since we last saw you? Recently received a vaccine? * Yes No Details: Dental Work? (recent or pending)* * Yes No Details: New Medications? * Yes No Details: Using new skin care products? * Yes No Details: Recent or upcoming injections (Botox or filler)? * Yes No Details: Taken Advil, Aspirin, or blood thinners in the last 24 hours? * Yes No Details: Cold sores without pre-medications? * Yes No Details: Currently pregnant or breastfeeding? * Yes No Details: Upcoming trip to a sunny destination? * Yes No Details: I consent to my likeness in the form of pictures or video for marketing purposes * Yes No I acknowledge that I have answered all questions truthfully and completely. * Yes No Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
