Health History Form

Welcome to W style Beauty. An accurate health history is important to ensure that it is safe for you to receive treatments. If your health status changes in the future, please let us know. All information gathered for this treatment is confidential except as required or allowed by law or except to facilitate diagnosis (assessment) or treatment.
●Previous history of massage therapy?
●Previous history of facial treatments?

PLEASE INDICATE CONDITIONS YOU ARE EXPERIENCING OR HAVE EXPERIENCED (SELECT ALL THAT APPLY)

●Do you have a primary complaint ? If yes Specify below

●Present involvement in other healthcare?

●Surgery - Date (MM/YY) and Nature

Thank you !