Please keep in mind I am looking inside a salon so these are not spa-like facials. I am provided result driven skin treatments to help you reach your skin goals.

TYPES OF SKIN TREATMENTS:

30 MIN EXPRESS FACIAL (most popular add on to any service)

60 MIN FULL SKIN TREATMENT USING GLYMED PLUS PRODUCTS

MICRODERMABRASION

DERMAPLANING

LIGHT TO MEDIUM PEELS

C02 FACIAL

FIBROBLAST SKIN TIGHTENING

Book an appointment

SHOP MY SKIN STORE FOR GLYMED PLUS RETAIL PRODUCT

Skin evaluation form

Must fill out form before first visit to customize a treatment for your specific needs.

Name *

First Name

Last Name

Email *

Phone

(###)

###

####

How did you hear about us? *

What are your skin concerns?

Have you ever had a facial?

What facial treatments have received in the past?

From a facialist, dermatologist, med spa

Follow up to above: Any of these in last 30-90 days? *

yes

If you clicked "Yes" please explain

Skincare History *

Please check products you have used in the last 6 months

face cream

makeup remover

eye makeup remover

toner

eye cream

sunscreen

serum

retinol

Doctor prescription

night cream

body scub

face scrub/ exfoliation

day cream

tinted moisturizer

neck cream

mask

Medical History *

This information is confidential and is needed to better understand your skin. Please check what applies

Accutane

HIV

Lupus

Facial surgery (includes eyes and every part of your face)

Psoriasis

Vitamins

Rashes

Warts

Acne

Depression

Diabetic

Thyroid Issue

Menopaus

Skin Cancer

Heart condition/ Cardio-vascular deficiencies

blood pressure

pacemaker or any other medical device with an electrical current

Eczema

Pregnant /Nursing

Retin- A

Allergy to Aspirin

Rosacea

Prone to Keloid

Auto immune disorder

Malignancy & Chemotherapy in past 3 years

Prone to pigmentation

Have metal plates, pins or other implants

What skin type/ condition do you have?

Where do you purchase your skin products?

Have you ever had a reaction to food, cosmetics, or skincare products?

If so please explain:

How much time do you spend on your daily skin routine and makeup routine?

Also do you have a morning and evening skin routine?

Do you smoke or drink often?

no judgement

How do you sleep?

on face

side

back

What do you hope to achieve with a facial treatment with Cristal Walker? *

We want to make sure we help you reach your goals even if that means referring you to someone who specializes in your concerns.

Notes

You can any additional information here if needed

Thank you!

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