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CQC WF Test 2
CQC Workflow Test
All Portal Forms
Menu Tidy
Treatments
All Aesthetics Forms
All Massage Forms
All Facials Forms
All Eyebrow And Lashes
Members
Register
My Account
Member Login
Member LogOut
Member TOS Page
Public Individual Page
Subscription Plan
Lost Password
Form Demos
Form Builds
Login / Medical
Default Redirect Page
Thank You Page
Checkout Page
Facials Forms
Geneo Oxy
Please complete the form as best you can.
BBL - Facials - Geneo OxyGeneo Facial Screening Form
Are you pregnant or breastfeeding?
Yes
No
Have you taken Roaccutane or isotretinoin in the last 6 months?
Yes
No
Active acne, eczema, psoriasis, rosacea or dermatitis on the face?
Yes
No
Cold sores?
Yes
No
Any skin infections, open wounds or sunburn on the face?
Yes
No
Botox or filler in the last 2 weeks?
Yes
No
Chemical peel, laser or microneedling in the last 4 weeks?
Yes
No
Currently using retinol, retinoids or exfoliating acids?
Yes
No
Do you scar easily or get dark marks after skin trauma?
Yes
No
Any known allergies to skincare ingredients?
Yes
No
Sensitive skin or previous reactions to facials?
Yes
No
Main skin concerns
Full
Name
Date of Birth
Date
Submit Form
CACI Microcurrent
Please complete the form as best you can.
BBL - Facials - CACI Microcurrent Facial Screening Form
Do you have a pacemaker or any implanted electrical device?
Yes
No
Do you have epilepsy?
Yes
No
Any metal plates, pins or implants in the face or head?
Are you pregnant?
Yes
No
Do you have a heart condition?
Yes
No
Do you have diabetes?
Yes
No
Have you had botox or filler in the last 2 weeks?
Yes
No
If Yes, please provide details
Do you have active acne, eczema, or broken skin on the face?
Yes
No
Do you have cold sores?
Yes
No
Have you had recent dental surgery or wear braces?
Yes
No
If Yes, please provide details
Have you had cancer currently or in the last 5 years?
Yes
No
Do you have sensitive skin or have had previous reactions to skincare products?
Yes
No
If Yes, please provide details
Main concerns and goals
Full
Name
Date of Birth
Date
Submit Form
Advanced Facials
Please complete the form as best you can.
BBL - Facials - Advanced Facial Treatment Screening Form
Are you pregnant or breastfeeding?
Yes
No
Have you taken Roaccutane or isotretinoin in the last 12 months?
Yes
No
Are you allergic to aspirin or salicylates?
Yes
No
Do you have active acne, eczema, psoriasis or rosacea on the face?
Yes
No
Details
Do you get cold sores?
Yes
No
Do you scar easily or get dark marks after skin trauma?
Yes
No
Have you had sun exposure, sunburn or used sunbeds in the last 2 weeks?
Yes
No
Have you had a peel, laser treatment or microneedling in the last 4 weeks?
Yes
No
Have you had Botox or filler injections in the last 2 weeks?
Yes
No
Are you currently using retinol, retinoids, hydroquinone or other acids on your skin?
Yes
No
Which products are you using?
Have you had previous peels or advanced facial treatments?
Yes
No
What treatments did you have and did you experience any reactions?
Do you have known allergies to skincare products?
Yes
No
Please provide details of your skincare allergies
Main skin concerns
Full
Name
Date of Birth
Date
Submit Form
Oncology Facial
Please complete the form as best you can.
BBL - Facials - Oncology Facial - Client Screening Form
Please tell us a little about your diagnosis and where you are in your treatment journey
Are you currently having chemotherapy, radiotherapy or immunotherapy?
Yes
No
Treatment type and most recent session date
Has your oncology team said gentle facial treatments are okay?
Yes
No
Unsure
Do you have a port, PICC line or any device fitted?
Yes
No
Where
Any lymph nodes removed?
Yes
No
Which side
Is your skin currently fragile, dry, sore or reactive?
Yes
No
Details
Any mouth ulcers, cold sores or infections?
Yes
No
Reduced sensation or neuropathy in the face?
Yes
No
Known allergies or new sensitivities since treatment?
Yes
No
Details
Anything that would make you more comfortable
Full
Name
Date of Birth
Date
Submit Form
Guinot Facial
Please complete the form as best you can.
BBL - Facials - Guinot Facial Screening Form
Do you have a pacemaker or implanted electrical device?
Yes
No
Do you have epilepsy?
Yes
No
Where do you have metal plates, pins or implants in the face or head?
Are you pregnant?
Yes
No
Recent dental surgery or braces?
Yes
No
Do you have active acne, eczema, psoriasis or rosacea?
Yes
No
Please provide details of your skin conditions
Do you have cold sores?
Yes
No
Do you have skin infections, wounds or sunburn on the face?
Yes
No
Have you had Botox or filler in the last 2 weeks?
Yes
No
Please provide details (what and when)
Have you had a peel, laser or needling treatment in the last 4 weeks?
Yes
No
Are you currently using retinol or acids on your skin?
Yes
No
Which retinol or acid products are you using?
Do you have any allergies to skincare products?
Yes
No
Please provide details of your skincare allergies
Main skin concerns
Full
Name
Date of Birth
Date
Submit Form
