Client Medical History Form

Please select all that applies:
ALLERGIES. Have you had any allergic reaction to any of the following?
Have you had any of the following done in the last 30 days? Please select all that applies:
HOME CARE. What skincare products are you currently using at home? Please select all that applies:
Please select if you are currently using or have used in the past any of the following:
Please select all applicable activities:
FITZPATRICK SCALE. When exposed to sun, do you:
Please select the box if you hav or had experienced any of the following conditions:

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