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Lifestyle

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Main Skincare Concerns

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Details
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Medical History

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Please list current medications
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Do you have any other medical condition that we should be aware of?
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Please list all known allergies
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I understand that it is my responsibility to inform Le Petit Spa of any changes to the information I have provided above.

This information will be kept confidential. We require your signature to keep your personal, treatment, and sales information on file. Thank you!

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