Guidelines for cosmetics therapy

NAME AND SURNAME:

E-MAIL:

AGE:

SYSTEMIC DISEASES

SURGICAL TREATMENT:

PREGNANCY:

MENSTRUATION CYCLE:

BLOOD PRESSURE:

RHEUMATIC DISEASES :

PACEMAKER:

DIABETES:

STRESS:

FILLER:

MEDICATIONS:

ALLERGIES TO MEDICATIONS

ALLERGIES TO COSMETICS

ALLERGIES TO SUN

ALLERGIES TO OTHER

SENSITIVITY ON:

CLEANSER:

TONER

PEELING

MASK

SERUM

CREAM

UV PROTECTION