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Client consultation form

Client information

Fields marked * are needed to create the completed consultation form.

May we email occasional Her Solis news and offers?
May we email your post-facial notes and home-care suggestions?
Health and treatment suitability

Share information that may affect treatment suitability or comfort. Her Solis provides complementary facial care, not medical diagnosis or treatment.

Relevant medical and wellbeing history

Select anything that applies now or may be relevant to your appointment.

Do you have allergies or intolerances, including foods, skincare or adhesives?
Hormonal or digestive considerations you would like us to know about?
Are you pregnant, breastfeeding or trying to become pregnant?
Skin and treatment history

Current skincare

Select products you currently use.

How would you describe your skin today?
Have you had a facial treatment before?
Have you used prescription acne medication?
In the last three months, have you used retinoids, vitamin A or exfoliating acids?
Have you had cosmetic injectables or a facial procedure in the last six months?

Current skin concerns

Consent and signature

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