Esthetics by Anna

Client consultation form

Let's get to know each other

This isn't a test, and there's no wrong answer. Fill out the sections that match what you're booking — waxing, a skin care service, or both — and skip the rest.

No computer, or is this too much trouble? No problem at all. We can go through it together at your visit.

Contact Information

Waxing Services

Only fill this out if you're booking a waxing service. A few questions so we can keep things safe and comfortable — please answer honestly, it helps me take good care of your skin.

If yes, that area (plus a 3" margin around it) will need to be skipped for this visit.

If yes, we won't be able to perform hair removal at this time.

If yes, I'll need a release from your provider confirming enough time has passed before we treat that area.

If yes, we'll do a quick patch test first to make sure the service is a good fit.

Water retention can cause temporary puffiness or redness, especially on the face — nothing to worry about, just something I like to know ahead of time.

Skin Care Services

Only fill this out if you're booking a facial or other skin treatment.

Health History

I ask about your health because I'm also a nutrition and health coach. Skin and whole-body health are closely connected, and knowing your history helps me see the whole picture.

By signing below, you confirm the information above is accurate to the best of your knowledge, and that you have not withheld any relevant information.

How to send this to me

  1. Fill in the sections that apply to you.
  2. Click Print this form below. In the window that opens, change the printer to Save as PDF and save the file to your computer or phone. (Or print it on paper and bring it to your appointment.)
  3. Open your own email and send the PDF (or a clear photo of the printed page) to service@estheticsbyanna.com as an attachment.

Please save your PDF before you leave this page, because what you type here isn't stored. There's no rush, and nothing here is graded.

Can't do this on a computer, or would you rather not? We can fill it out together at your visit.

© 2026 Esthetics by Anna · Anna Piekunko, Licensed Esthetician