Intake Form
Are you currently using or taking: Accutane, Adapalene, Alustra, Avage, Avita, Differin, Isotretinoin, Renova, Retin A, Tazarac, Tazarotene, Tretin?
Do you have tendencies towards : ingrown hair, break outs, or bumps?
Do you have tendencies towards : hyperpigmentation, bruising, or scarring?
Do you have tendencies towards : eczema or psoriasis?
Are you a carrier of the herpes virus?
Are you currently using: alpha-hydroxy acid, glycolic acid, any scrubs or peels?
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