The Skin Edit · Abbotsford, BC

Consultation Cosmetic
Pre-Assessment Survey

Please complete this survey before your consultation. Your answers help us understand your goals and tailor your treatment plan.

Client Information

Full Name

DOB

Tel#

What specific cosmetic issues are you concerned about?

Check all that apply.

Fine lines and wrinklesDark under-eye circlesSagging skin (jowls, "turkey neck" etc.)Crow's feet (wrinkles around eyes)Dark spots (aka sunspots or age spots)Acne, oily skinBlemishes, scarringRosaceaFacial Veins"Eleven's" (vertical lines in between eyes)Dull SkinDry Skin

Have you tried any products/treatments in the past to fix these concerns? If so, please share:

What is your daily skincare regime? Please share any details, including creams, toners etc.

How would you like to look after treatment?

Check all that apply.

I want to look less tired.I want to look less angry.I want to look less sad.I want a less saggy appearance.I want to look more youthful.

Would you like to sustain this look after you achieve it?

YesNo

How long have you been thinking about getting aesthetic treatment?

Past few daysPast few weeksPast few monthsFor years

Is there any specific reason or event why you are interested in treatment now?

Please complete all required fields before submitting.

Consultation CosmeticPre-Assessment Survey

Client Information

What specific cosmetic issues are you concerned about?

How would you like to look after treatment?

Consultation Cosmetic
Pre-Assessment Survey