Before Your Visit
Client Forms
Please complete the appropriate form before your appointment. You can fill it out online and print it, or bring it with you.
New Client Intake Form
Complete this form on your first visit. Includes personal information, skin type, concerns, and product preferences.
Ancient Esthetics Soap Studio & Skin Care · 72 South Main Street, Suite 028, Pecos, NM 87552 · 505.372.8199
Personal Information
Skin Profile
Skin Type (select all that apply)
Primary Skin Concerns (select all that apply)
Current Skincare Routine
How often do you wash your face?
Do you wear sunscreen daily?
Known Allergies & Sensitivities
Goals & Preferences
Health History Form
Required for all facial and skin treatment services. Helps us provide safe, personalized care.
Ancient Esthetics Soap Studio & Skin Care · 72 South Main Street, Suite 028, Pecos, NM 87552 · 505.372.8199
General Health
Medical Conditions
Please check any that apply or have applied in the past:
Skin & Treatment History
Have you had any of the following? (select all that apply)
Lifestyle
Do you smoke or use tobacco products?
How would you rate your water intake?
Stress level (general)
Additional Notes
Service Consent Form
Acknowledgment and consent for esthetician services. Required before treatment begins.
Ancient Esthetics Soap Studio & Skin Care · 72 South Main Street, Suite 028, Pecos, NM 87552 · 505.372.8199
Client Information
Consent & Agreement
I, the undersigned, voluntarily consent to receive esthetician services provided by Ancient Esthetics Soap Studio & Skin Care. I understand that esthetician services are not a substitute for medical treatment and that my esthetician is not a licensed medical professional.
I confirm that I have accurately completed the New Client Intake Form and Health History Form to the best of my knowledge. I understand that withholding or misrepresenting health information may affect the safety and outcome of my treatment.
I acknowledge that some services may involve the use of professional-grade products, tools, and techniques. I understand that individual results may vary and that no specific outcome is guaranteed.
I agree to inform my esthetician of any changes to my health, medications, or skin condition at each subsequent visit. I understand that certain medical conditions or medications may contraindicate specific treatments.
I release Ancient Esthetics Soap Studio & Skin Care and its practitioners from liability for any adverse reactions that result from undisclosed health conditions, allergies, or medications.
Signature
Parent / Guardian (if client is under 18)
Questions about your forms or appointment? Don't hesitate to reach out.