Impotentie brengt een constant ongemak met zich mee, net als fysieke en psychologische problemen in uw leven cialis kopen terwijl generieke medicijnen al bewezen en geperfectioneerd zijn

Imagecenter.info

ARE YOU CURRENTLY UNDER THE CARE OF A DERMATOLOGIST OR A PHYSICIAN FOR YOUR SKIN? (IF YES, EXPLAIN) ____________________________________ ________________________________________________________________________NAME OF PHYSICIAN: __________________________________ HAVE YOU EVER SEEN A DERMATOLOGIST, OR OTHER PHYSICIAN FOR YOUR SKIN? (IF YES, EXPLAIN) _______________________________________________ ________________________________________________________________________NAME OF PHYSICIAN: __________________________________ WHAT SKIN CARE PRODUCTS DO YOU USE TO CLEANSE YOUR FACE? _______________________________________________________________________ WHAT SKIN CARE PRODUCTS DO YOU USE TO MOISTURIZE YOUR FACE? _____________________________________________________________________ AGGRESSIVE EXFOLIATION TREATMENT IN THE LAST 2 WEEKS? (EXPLAIN) _________________________________________________________ ALPHA-HYDROXY ACIDS DATE: _________________________ TOPICAL FLOUROURACIL PREPERATION (WHEN & WHAT AREA OF YOUR BODY): ____________________________________________________ OTHER (INCLUDE TOPICAL ANTIBIOTIC, OTC ACNE REMEDIES, ETC.): _____________________________________________________________ IF YES, WHAT IS THE DOSAGE AND FREQUENCY: ___________________________________ IF YES, LAST TAKEN ON: _____________________________________________________ HYPERSENSITIVITY AND SKIN FRAGILITY
HAVE YOU EVER HAD A SKIN ALLERGY OR SENSITIVITY (RASH, IRRITATION, PEELING, SWELLING, HIVES, ETC.) TO: OTHER (LATEX, ETC.)? _______________________ DO YOU HAVE ANY KNOWN SYSTEMIC ALLERGIES TO ANYTHING? (IF YES, PLEASE LIST) ___________________________________________________ _______________________________________________________________________________________________________________ DO YOU “FLUSH” OR “APPEAR REDDENED” EASILY WHEN YOU EAT SPICY FOOD, DRINK ALCOHOL, GET ANGRY, GO IN THE SUN, ETC.? 7 8 0 1 C e n t e r A v e n u e S u i t e 2 0 2 · H u n t i n g t o n B e a c h C A 9 2 6 4 7 · 7 1 4 . 2 3 0 . 2 4 4 0 · 7 1 4 . 2 3 0 . 2 4 4 1 f a x FREE RADICAL EXPOSURE
HOW OFTEN & TYPE: ____________________________________________ HOW MUCH? __________________________________________________ HOW MUCH? __________________________________________________ LIST ANY DIETARY CONCERNS: _____________________________________ EXPLAIN: _____________________________________________________ IF NOT HOW MUCH? ____________________________________________ TYPE OF VITAMINS: _____________________________________________ ANTIOXIDANTS: ____________________________________ OTHERS: _____________________________________________________ FOR WOMEN ONLY
DURING PREGNANCY DID YOU EVER EXPERIENCE HYPERPIGMENTATION OR A “PREGNANCY MASK”? PIGMENTATION (FITZPATRICK SCALE)
OTHER: ____________________________________________ WHAT IS YOUR NATIONALITY (HERITAGE)? _____________________________________________________________________________________ VASCULARITY
DO YOU HAVE ANY HISTORY OF ACNE OR PERIODIC BERAKOUT? DO YOU ONLY EXPERIENCE A BREAKOUT AROUND YOUR MENSTRUAL CYCLE? DO YOU ALWAYS HAVE A PIMPLE OR SOME TYPE OF BREAKOUT? FACIAL WRINKLES
7 8 0 1 C e n t e r A v e n u e S u i t e 2 0 2 · H u n t i n g t o n B e a c h C A 9 2 6 4 7 · 7 1 4 . 2 3 0 . 2 4 4 0 · 7 1 4 . 2 3 0 . 2 4 4 1 f a x SKIN TYPE
DOES YOUR SKIN EVER FLAKE OR FEEL TIGHT AND DRY? IS YOUR SKIN EVER SHINY A FEW HOURS AFTER CLEANSING? HOW OFTEN DO YOU EXPERIENCE BLACKHEADS OR BLEMISHES? ABILITY TO HEAL
DOES YOUR SKIN APPEAR FRAGILE OR BURN EASILY? IF YES, EXPLAIN: ______________________________ DO YOU HAVE ANY PROBLEMS HEALING FROM A CUT OR BURN? IF YES, EXPLAIN: ______________________________ DO YOU EVER USE DEPILATORIES OR WAXES ON YOUR FACE? IF YES, EXPLAIN: ______________________________ IF YES, EXPLAIN: ______________________________ SUN HISTORY & LIFESTYLE
OCCUPATION: ________________________________ HOBBIES: ___________________________________ IN THE PAST (INCLUDING CHILDHOOD) DID YOU LIVE IN A SUN BELT? WHERE DID YOU LIVE? __________________________ IN THE PAST HAVE YOU NEGLECTED TO USE A SUNSCREEN? IF YES, EXPLAIN: ______________________________ IF YES, WHEN? ________________________________ DO YOU CURRENTLY WEAR A SUN PROTECTION PRODUCT ALL DAY, EVERYDAY? ARE YOU WILLING TO WEAR A SUN PROTECTION PRODUCT ALL DAY, EVERYDAY? HAVE YOU OR ANY MEMBER OF YOUR FAMILY HAD SKIN CANCER? IF YES, WHO? _________________________________________ ANATOMICAL LOCATION: _________________________________________ ENVIRONMENTAL POLLUTION
HOW DO YOU WANT TO IMPROVE YOUR SKIN? _______________________________________________________________________________________ _____________________________________________________________________________________________________________________ WHAT SPECIFIC AREAS DO YOU WANT TO TREAT? SKIN CARE CONSENT: I understand that although the products used for facial and body treatments at Minuet Day
Spa is of the highest quality, it is possible that I may have an adverse reaction to a product or treatment. I understand that the risk of an adverse reaction is extremely low, however I accept the risk and consent to treatment by the thera-pists at Minuet Day Spa.
CLIENT SIGNATURE: ___________________________________________________________________________ DATE: _________________________
THERAPIST SIGNATURE: _______________________________________________________________________ DATE: _________________________
7 8 0 1 C e n t e r A v e n u e S u i t e 2 0 2 · H u n t i n g t o n B e a c h C A 9 2 6 4 7 · 7 1 4 . 2 3 0 . 2 4 4 0 · 7 1 4 . 2 3 0 . 2 4 4 1 f a x

Source: http://www.imagecenter.info/spa/SPA_SkinCare_Q_b&w.pdf

Document

SICHERHEITSDATENBLATTgemäß Verordnung (EG) Nr. 1907/2006 (REACH) Art. 2280, INSEKT-EX 1. Bezeichnung des Stoffes bzw. des Gemischs und des Unternehmens Produktidentifikator Bezeichnung / Handelsname: REACH Registrierungsnr.: Relevante identifizierte Verwendungen des Stoffs oder Gemischs und Verwendungen, von denen abgeraten wird Verwendung des Stoffes / des Gemisches: Ein

Microsoft word - lilly_controls_forigin.doc

UBERMORGEN.COM (lizvlx/Hans Bernhard) Lilly controls my Foriginals For their first Italian personal exhibition, the Austrian artist duo UBERMORGEN.COM (lizvlx/Hans Bernhard) is showing a synthesis of their recent work -- a subtle membrane connecting the digital and the biological: a mix that UBERMORGEN.COM, an identity that lives and works on the Net, experienced on their own bodies. One o

Copyright © 2010-2014 Online pdf catalog