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Skin intake form (helps us prepare; saved with your booking)

Skin type

First visit?

Facial Skin Concerns

Acne & breakouts
Acne scarring & post-inflammatory marks
Fine lines & wrinkles
Loss of firmness / sagging skin
Dull or uneven skin tone
Hyperpigmentation, dark spots & melasma
Sun damage
Large pores & rough texture
Dryness / dehydration
Oiliness & excess sebum
Sensitivity / redness
Rosacea
Under-eye concerns (dark circles, crepey texture, puffiness)

Any underlying conditions that could affect your skin?

Any pre-existing allergies?

Please note: if you’ve had Botox or filler within the last 7 days, we’re unable to provide a facial service.

Have you had Botox or filler in the last 7 days? *(required)

Current medications or actives

Recent treatments (2 weeks)

Pregnant or nursing?

New client? Who referred you? (optional)

Your friend gets a Newd glow credit (50% off their next facial) when you book your first visit.

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Questions? Call 661.617.0501.

newdskin

Esthetician studio · NeuroAesthetics. Reset your nervous system through sensory relaxation and restorative rituals.

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Visit

1412 17th St, Ste 224
Bakersfield, CA 93301

Hours

Tue & Thu: 1 – 6 PM
Wed & Fri: 10 AM – 6 PM
Sat: By appointment
Sun & Mon: closed

Connect

661.617.0501
Stephanie@newdskin.com
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We accept

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