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L'eau Natural | Holistic Skincare & Wellness — Holistic Skin Consultation

Welcome to L’eau Natural! 🌿

We’re happy to be part of your skincare journey.

This short consultation helps us get to know your skin, lifestyle, and personal needs so we can create a relaxing, personalized facial experience just for you.

Estimated time: 3–5 minutes.
Your information is kept private and used to personalize your facial experience.

About You

Full name

Phone number

Email address

Service booked

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Appointment date

Your Skin

How would you describe your skin type?

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B
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What are your main skin concerns?

What is your main goal for this facial?

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Which of these are part of your current skincare routine?

Do you currently use any active ingredients?

Allergies & Safety

Are you allergic or sensitive to any of the following?

Have you ever had a reaction to a facial or skincare product?

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B

Are you currently using any medication that affects your skin, or does any of this apply?

Are you currently pregnant or breastfeeding?

Some products and techniques are adjusted during this stage, so this helps us care for you safely.
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In the last 4 weeks, have you had any of the following?

Do you currently have any of the following on your face?

Anything else we should know to care for you safely?

Your Holistic Lifestyle

At L'eau Natural, we believe your skin reflects how you live. These few questions are completely voluntary — they simply help us offer realistic, personalized recommendations.

How would you describe your usual eating habits?

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How much water do you drink on a typical day?

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How many hours do you usually sleep?

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B
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How would you describe your current stress level?

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How active are you in a typical week?

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How often do you wear sunscreen?

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Consent & Policies

I understand that my facial is a cosmetic and wellness service provided by a licensed esthetician, and it is not a medical treatment or diagnosis. Mild, temporary effects such as redness or sensitivity may occur. I will let my esthetician know about any discomfort during my treatment, and about any changes in my health, medication, allergies, or pregnancy before future appointments. The information I shared in this form is true to the best of my knowledge.

A deposit secures your appointment — $25 for in-studio facials and $50 for mobile facials — and is applied to your total. Please cancel or reschedule at least 24 hours in advance to receive a full deposit refund; deposits for late cancellations or no-shows are kept. Mobile services are by request and confirmed in advance; the travel fee is separate and based on distance.

Full legal name

Signature

Signature

Privacy Notice

Privacy Notice — L'eau Natural collects the information you share in this form only to prepare and personalize your facial and to care for your skin safely. Your answers are stored securely in our form provider's encrypted system (Tally, with servers in Europe and GDPR protections) and protected by our account password. Only Judith Sosa, owner and licensed esthetician of L'eau Natural, can access your responses. We never sell your information or share it for marketing. We keep your signed form in your client file and delete old online submissions periodically, keeping information only as long as needed for your care and our records. You may at any time ask what information we hold about you, ask us to correct it, or ask us to delete it — just contact L'eau Natural through our booking page and we will take care of it promptly. This form supports cosmetic and wellness services; it is not a medical record.