Aesthetic Intake Form

Experience a more personalized approach to aesthetic care. Your consultation is designed to help your provider understand your concerns, priorities, treatment history, and desired outcome. During your visit, your provider will assess your skin and facial or body anatomy, review your current skincare routine, and discuss appropriate treatment options based on your goals, medical history, timeline, and comfort level.

Please bring the skincare products you currently use. Your provider will consider what is already working for you and recommend only the changes that may add value as part of a customized aesthetic plan.

A $75 consultation fee is collected as part of this comprehensive evaluation. The full fee will be applied toward any aesthetic service, skincare purchase, or package purchased on the same day as your consultation.

Please bring the skincare products you currently use to your consultation. We will consider what is already working for you and recommend only targeted additions, substitutions, or adjustments that may improve your routine.

I understand that this intake supports my aesthetic consultation and medical evaluation. Completing this form or paying the consultation fee does not guarantee that I am a candidate for, or will receive, any procedure, product, prescription, or treatment.

I certify that the information I provided is complete and accurate. I agree to disclose relevant medical conditions, allergies, medications, previous procedures, and complications that may affect my care.

I understand that my provider will use my goals, medical history, examination findings, risk factors, expected benefits, and clinical judgment when making recommendations. My provider may delay or decline treatment, request additional information, or recommend evaluation by another clinician.

Aesthetic results vary, and no specific result, duration of effect, or complication-free outcome can be guaranteed. This acknowledgment applies only to the consultation and evaluation. Before treatment, I will have an opportunity to review the recommended procedure, benefits, alternatives, risks, limitations, aftercare, and warning signs, and I may be asked to sign a separate treatment-specific consent.

A $75 consultation fee is collected for my personalized aesthetic evaluation. If I purchase an aesthetic service, skincare product, or treatment package during the consultation, the full fee will be applied to that same-day purchase. Payment does not guarantee that a procedure will be recommended or performed.

I understand that cancellations, rescheduling, missed appointments, no-shows, consultation fees, and refunds are governed by Feel Ideal 360’s current policies.

By signing below, I confirm that I have read and understand this acknowledgment and voluntarily consent to the consultation and evaluation described above.