Returning Client Health Update

Welcome back to DEMRÉ Clinical Spa. This quick update takes less than 2 minutes and helps us ensure your treatment is safe and tailored to your current health.

Section 1 – Client Verification

Full name

Date of birth

Month

Day

Year

Appointment date

Section 2 – Health Update

Please answer the following questions about any changes since your last visit.

Have you started any new medications?

Yes

Have you started using Retinol, Retin-A, Tretinoin, Accutane, or any prescription acne medication?

Yes

Are you currently pregnant or breastfeeding?

Yes

Have you developed any new allergies?

Yes

Have you been diagnosed with any new medical conditions?

Yes

Have you had Botox, fillers, laser treatments, chemical peels, or any cosmetic procedures since your last visit?

Yes

Section 3 – Treatment Update

How would you describe your skin since your last visit?

Are there any new concerns you would like to address today?

Section 4 – Consent

Please read and confirm each statement below before signing.

I confirm the information provided is accurate.

I understand my treatment plan may be adjusted based on today's assessment.

I consent to receiving today's treatment.

Section 5 – Electronic Signature

Full name

Date

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Returning Client Health Update

Welcome back to DEMRÉ Clinical Spa. This quick update takes less than 2 minutes and helps us ensure your treatment is safe and tailored to your current health.

Section 1 – Client Verification

Full name

Date of birth

Month

Day

Year

Section 2 – Health Update

Please answer the following questions about any changes since your last visit.

Have you started any new medications?

Yes

Have you started using Retinol, Retin-A, Tretinoin, Accutane, or any prescription acne medication?

Yes

Are you currently pregnant or breastfeeding?

Yes

Have you developed any new allergies?

Yes

Have you been diagnosed with any new medical conditions?

Yes

Have you had Botox, fillers, laser treatments, chemical peels, or any cosmetic procedures since your last visit?

Yes

Section 3 – Treatment Update

How would you describe your skin since your last visit?

Are there any new concerns you would like to address today?

Section 4 – Consent

Please read and confirm each statement below before signing.

I confirm the information provided is accurate.

I understand my treatment plan may be adjusted based on today's assessment.

I consent to receiving today's treatment.

Section 5 – Electronic Signature

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.