AMARA™ CLIENT INTAKE QUESTIONNAIRE

Your session is individualized to you. This brief questionnaire helps me understand your skin, your body, and anything that may help me prepare for your appointment.

1. Which Amara experience are you booking?

2. Contact Information

3. What brings you in today?

Select anything that applies:

4. What have you been noticing in your body recently?

5. How has your body been feeling lately?

6. How have you been sleeping?

7. Tell me about your skin.

Select anything that applies:

8. Have you recently had any facial or aesthetic treatments?

9. Are you currently experiencing any of the following?

10. Are you currently under the care of a physician, physical therapist, chiropractor, or other healthcare professional for anything that may affect your session?

11. Are there any areas you prefer not to have touched?

12. Is there anything that helps you feel more comfortable during a session?

FINAL QUESTIONS

18. What would you most like from your session today?

19. Is there anything else you would like me to know before your appointment?

ACKNOWLEDGMENT

I understand that The Amara Method™ is a wellness and esthetic experience and does not diagnose, treat, or rehabilitate medical conditions or injuries. I understand that I should inform Isis of any changes in my health, recent procedures, injuries, or areas of concern before my session.