Facial Intake Form — Glam Lab PDX

Please complete the highlighted fields before continuing.

Step 1 of 4

Client Information

First name

Last name

Birthday

Mobile number

Gender

Address

Step 2 of 3

Skin Profile

Have you had a professional facial before?

How would you describe your skin type?

What are your main skin concerns or goals? (Acne, texture, dryness, anti-aging, hyperpigmentation, redness, etc.)

Walk us through your current skincare routine — what products do you use morning and night?

Are you currently using retinol, retinoids, tretinoin, or exfoliating acids (AHA/BHA)?

Have you taken Accutane (isotretinoin) in the last 12 months?

Have you had any treatments in the last 4 weeks? (Chemical peel, microneedling, laser, Botox or filler, facial waxing, etc.)

Please list any allergies or sensitivities (skincare ingredients, fragrance, latex, nuts, etc.) and any medications you're taking.

Are you currently pregnant or nursing? (Some ingredients and treatments will be adjusted to keep you both safe.)

Step 3 of 3

Policies & Agreement

Assumption of Risk: I understand that beauty services, including but not limited to facials and skincare treatments, carry inherent risks, including possible allergic reactions, irritation, or sensitivities. I voluntarily assume all risks associated with these services.

Allergy & Reaction Disclaimer: I confirm that I have disclosed any known allergies or sensitivities. I understand that the service provider is not liable for any allergic reactions or adverse effects resulting from the service or products used.

Release of Liability: I release the service provider and Glam Lab PDX from any liability for any reaction, injury, or dissatisfaction resulting from the service. I waive any claims against the business or its staff for damages, injury, or loss.

Aftercare Responsibility: I understand that proper aftercare is my responsibility. After my facial I will follow my esthetician's recommendations, including avoiding makeup for the rest of the day when advised, wearing SPF daily, and pausing strong actives (retinoids and exfoliating acids) for 48–72 hours. Failure to follow these guidelines may affect my results.

✓

You're all set!

Your facial intake form has been received. We can't wait to see you at the Lab — come with clean or lightly made-up skin and we'll take care of the rest.

Book your appointment →