Getting to Know You!

Your feedback is invaluable to us as we strive to provide the highest quality treatments and services. This survey is designed to gather your insights in order to enhance your experience, and ultimately achieve the best possible outcomes for your wellness goals.

Name*

Date of Birth*

Email*

Phone*

Please check yes or no to all that apply

Do you currently have a daily skincare routine that you follow consistently?

Yes

Have you ever experienced acne breakouts, either currently or in the past?

Yes

Have you ever considered or tried injectable treatments, such as Botox or fillers?

Yes

Do you have any concerns about fine lines or wrinkles appearing on your skin?

Yes

Have you noticed any areas of hyperpigmentation or uneven skin tone?

Yes

Have you ever explored laser hair removal as an option for unwanted hair?

Yes

Are you interested in learning more about skincare ingredients or treatments that could address your specific concerns?

Yes

Would you be open to trying new products or adjusting your current routine if it could potentially improve your skin's appearance?

Yes

Do you have any allergies or sensitivities to specific skincare ingredients or products?

Yes

Are there any particular skincare goals you would like to achieve, such as clearer skin, smoother texture, or a more even complexion?

Yes

Do you have a tattoo you've considered removing?

Yes

On a scale of 1 to 5, with 5 being the top concern, and 1 being lowest concern please rank the following:

Fine Lines/Wrinkles

Age Spots/Sun Damage/Hyperpigmentation

Body Hair/Facial Hair

Acne

Unwanted Tattoo

When is the best time to reach you?*

Do you prefer call, email or text?*

What days and times are the easiest for you to schedule appointments?*

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Contact Info

125 N. La Grange Rd.
La Grange, IL 60525
(708) 726-0363
info@ariabymetro.com
Mon - Fri: 9:00 AM - 6:00 PM
Sat - Sun: Closed

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