Before your appointment

The consultation form.

Five minutes now saves ten at the start of your appointment, and means I can tell you in advance if anything needs adjusting or rescheduling. Please fill it in before your first visit, and again if anything has changed since the last one.

Website

About you

Name *

Phone *

Email *

Used to confirm your appointment and nothing else.

What you are interested in

Facials Brows Lashes Nails Not sure yet — happy to be advised

Is this your first visit? *

Yes No, I have been before

Health

All of this changes what is safe and sensible to do, and some of it means waiting rather than pressing ahead. If in doubt, write it down — it is easier to work around something known.

Are you pregnant or breastfeeding? *

Yes No Prefer not to say

Do you have a pacemaker or any implanted electrical device? *

Yes No

Some facial equipment uses a low electrical current, which is not suitable with a pacemaker or a similar device. There is plenty I can still do — I just need to know first.

Known allergies

Current medication

Any peels, retinol, laser or other skin treatments in the last 4 weeks?

Yes No

If yes, what and when?

Skin conditions or sensitivities

Have you ever reacted to a beauty product or treatment?

Yes No

If yes, what happened?

Have you already had a patch test with me? *

Yes No Not sure

Brow tints and LVL lash lifts cannot go ahead without one done at least 24 hours beforehand.

Anything else I should know?

Consent

I agree to Jessica using the health information above to decide whether a treatment is safe and suitable for me, and to contact me about my appointment. Your answers are emailed to Jessica and to nobody else. They are not stored on this website, not shared, and never used for marketing. Kept for up to 12 months, then deleted. Read the full privacy notice.

Send the form

Sent straight to Jessica. Nothing is stored on this website.