Alpenglow Consultation Form

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Retin-A
Tretinoin
Differen
EpiDuo
Tazorac
Accutane
Clindamycin
Spironolactone
Other
No
Yes
No
Yes
Aspirin
Nuts
Gluten
Ragweed
Lavender
Hydroquinone
Chamomile
***IMPORTANT - Please List ALL allergies:
Eczema
Psoriasis
Dermatitis
History of Skin Cancer
History of Skin Cold Sores
Other
Normal
Dry
Oily
Sensitive
Combo
No
Yes (no tags, eyes closed or covered)
Yes
No
Yes
***New data proves screen lighting and indoor LED lighting damages skin
No
Yes
Hyperpigmentation/Melasma/Sun Damage
Sensitivity/Rosacea/Redness/Flushing
Aging/Fine Lines/Wrinkles/Collagen Loss
Blackheads/Pimples/Breakouts
Cystic Acne/Scarring
Uneven Skin Tone/Uneven texture/Large Pores
Impaired Barrier Function/Dryness/Dehydration/Flakiness
Other
No
Yes
***Some of these products will be changed seasonally or as your skin changes into a maintenance plan









No
Yes
***This is most important for acne clients
No
Yes
None/All Natural
Light/Sheer Coverage
Medium Coverage
Photo Finish/Full Coverage
Bare Minimum 1-3
A Good Start 2-4
A Complete System 4-6
Whatever it Takes 6-8
No
Yes
No
Yes
No
Yes
***Let me know if you need a good referral. This is very important for skin health.
1    2    3    4    5    6    7    8    9    10
No
Yes

Other Important Information about our Virtual Product Consultation & What to Expect

Consultation Agreement: Please Review & Check Each Box Below

The skin takes about 3-4 weeks to adjust to new products & actives, please stay in communication with me during this process so that if you have any questions, I can help you. It's common with increased cellular turnover, the skin can feel a little tight, scaly or dry until hydration, moisture levels & PH is balanced. If you have acne it is rare but possible to have increased purging breakouts while the skin is clearing. Please have patience with this process. The skin should never have a rash, extreme itchiness or welts so please know that there is a difference between tingly exfoliation & active skincare versus a true allergic reaction. It's very rare to have an allergy to any of my products so this isn't something you need to worry about, but please keep me in the loop during this process.
After this form is emailed to me, I'll need you to send me 3-6 photos of your face with no makeup, good lighting, front and sides so I can analyze your skin. I will review your photos & form and write up a product regimen specific for targeted skin concerns & goals that we have.
This is collaborative effort & we are a team effort creating these results. Check in with me via email: alpenglowskinspa@gmail.com and follow-up anytime with progress photos & questions, I'm your personal skin coach but can only help you if we stay connected. I don't charge for follow-ups.
The product system should last anywhere from 4-6 months or more. Some products last longer than others. Never run out of something completely, if you are getting low- replenish on my online store so that I can keep track of your skin's progress & check in periodically if we need to change or add anything. I will be managing your system long-term and helping you achieve your skincare goals as your virtual Esthetician. Please discontinue all other products & makeup so that they don't interfere or delay our intended results.
Important Consumer Warning: Please do not purchase my recommended products elsewhere since there are so many unauthorized retailers on the internet & it's important not to support product diversion through fraudulent accounts, expired goods, inauthentic & counterfeit professional products. They can also be heat damaged, illegally diverted & possibly dangerous for the skin since they cannot be verified.
When you purchase through my spa, you are purchasing professional product brands from a Licensed Esthetician with 15 years experience & is an authorized expert and trained to retail & use these products in the treatment room & recommend them for home-care in a tried & true manner for actual clients. I have a 99% rate of guaranteed results and no returns due to expert customization for your unique skin. If on the off chance you don't love something or have a reaction- I'll work with you completely to make you happy. You're also supporting my small business when you replenish your products in my online store since I invest in physical inventory for my clients to access and personally ship items myself or utilize drop-shipping through my brands when necessary.
After this form is submitted, I'll email you an invoice of product items I recommend and once purchased will email you a detailed step by step regimen plan for you to execute at home. If you ever want to do virtual at-home facial treatment I can walk you through that on FaceTime or Zoom just let me know. I normally charge $79 for this consultation, but if the recommended products are purchased- I let the service fee be applied to your product purchase. I'm excited to work with you and get started on this skincare journey together.
*I understand skin care services and recommendations are not a substitute for medical examination, diagnosis, or treatment. I am aware that certain medications and over the counter products can significantly increase the risk of injury when combined with skin care services. I will not hold Courtney Parkhill at Alpenglow Skin Spa responsible should there be any unfavorable results for this appointment or any future appointments. I have read and agreed to all post-procedure guidelines. I agree to refrain from sun exposure, tanning beds, and understand there may be no guarantee as to the results of this treatment, due to many variables such as: age, diet, hormones, condition of skin, sun damage, smoking, climate, compliance, commitment, proper home-care product usage, etc. I understand the treatment is cosmetic and that no medical claims are expressed or implied. Lastly, I understand that I should follow my esthetician's recommendations for prep/post-procedure to minimize side effects and maximize results.