• Mon. - Fri., 9.00 am-5.00 pm (Appt Only)
  • 12004 Carmel Mountain Rd Suite 48, San Diego, CA 92128
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Intake Form
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Intake Form

Help us personalize your experience. Please complete the intake form so we can tailor your skincare treatment to your unique needs and goals.

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Customer Details

Full Name
Address
Do you have any allergies or health concerns we should know about?
Are you pregnant or breastfeeding?
Do you have any pain in any part of your body that can effect your daily activity?
Which service are you interested for today or future?(Choose as many as you are interested)
How would you describe your skin or your biggest concerns?
Are you on any of these medication?
Have you been waxed or threaded on your face in the last 7 days?
What does your skincare regimen look like?
Are you consistent with your skin home care?
Have you ever had any of these treatment in the past?
Were you ever treated for skin condition from your dermatologist ?
I consent to perform skin treatments on myself. I understand I will follow all post treatment care and follow directions. I will make sure to contact Sara Jahromi with any questions and make sure I am truthful with my intake form. I agree that I am not on any medications that could potentially be a contraindication.
I understand and accept that any skin treatments may have risks and reactions, as individual skin types can vary in response.
I agreed to take a picture of my face and skin to be shared on social media
OUR POLICIES: We kindly ask that you allow at least 48 hours notice to avoid a cancellation fee. We will charge 50% of the scheduled service. All services require a credit card at the time of booking.