GLOWDEGA Initial Consultation 

Do you have any medical conditions that have been previously diagnosed and confirmed by a health care professional?

Are you currently on any medications?

Do you have any allergies?

Are you satisfied with your current skin care/lifestyle routine?

I expect to see results from products within one month of purchasing

I expect to see results from products within 6-8 weeks of purchasing

I rarely see results from products so I don't have any expectations

I confirm that I have completed this form truthfully and to the best of my ability

I understand that the information in this form is only used to communicate information necessary to receive treatment(s) at Glowdega and will not be shared with any third parties.

I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from the treatments I received at Glowdega.

I understand this is a cosmetic procedure with risks and potential side effects, and I voluntarily wish to have the services provided with knowledge of the potential side effects.

I understand that it is completely normal to experience tightness, dryness, light irritation, and purging of the skin due to the professional exfoliation received in my treatment at Glowdega.

I understand that my failure to follow post care instructions may also lead to undesired results, complications or effects.

I acknowledge that the treatments I receive at Glowdega are completely voluntary and I release Fairy Glow Mother, LLC dba Glowdega as well as their employed skin care professionals from any liability.

GLOWDEGA Initial Consultation

ABOUT US

ABOUT YOU

What is your name?

Contact Number

Please enter your email

How old are you?

What is your ultimate glow up goal? You can include the ideal changes you'd like to see in your skin and nutritional health.

Please select all concerns below that best describe your reason for booking an appointment with Glowdega.

If applicable, how long has Acne been a concern for you?

If other, please describe below.