New client intake

Euphoria Electrology

A few questions before your first appointment. Takes about 5–7 minutes. Your answers stay private and are only visible to your practitioner.

About you

First name *Last nameEmailPhone

Your goals

What are you hoping to achieve?Treatment areasHow concerned are you about this hair?Anything special you want us to know?

Hair removal history

Previous electrolysis?

Previous laser?

Current hair removal method (if any)

Skin

Skin sensitivityMy skin scars easily

Medical history

Currently under physician care?

Currently taking medications?

Have allergies?

Any of these conditions?

PCOSHormonal imbalancesThyroid disorderDiabetes (Type 1 or 2)Adrenal disorderSeizures, epilepsy, or faintingMultiple sclerosisNeuropathy or nerve damageMigrainesHigh or low blood pressureHeart diseaseBleeding/clotting disordersLupusRheumatoid arthritisFibromyalgiaKeloid or hypertrophic scarringCold sores / herpesCancerHIV/AIDSAnxiety or panic disorderPTSDDepression

Any of these devices/implants?

Pacemaker or defibrillatorCochlear implantIUDJoint replacementMetal plates / pins / surgical hardwareInsulin pump or glucose monitorDental implants or metal orthodonticsDermal fillersBotox / Dysport / neurotoxins

Recent skin treatments (last 6 months)?

Antibiotics (oral or topical)Accutane (Isotretinoin)Retinoids (Retin-A, Tretinoin)Glycolic / AHA / BHA treatmentsChemical peelsLaser or light-based treatmentsBotox, fillers, or injectionsTanning or sunburnMicrodermabrasionSurgery / stitches / open wounds in the area

Substance use

AlcoholCaffeineNicotine / tobaccoRecreational drugs (cannabis, etc.)Hormone therapy (HRT, birth control, testosterone)DiureticsAnabolic steroidsNone of the above

Anything else we should know about your health?

Lifestyle

I exercise regularlyAverage sleep per nightI drink water regularly through the day

Consent

Please confirm:

I consent to electrolysis treatment.I understand redness, swelling, and minor scabbing are normal post-treatment.I will follow aftercare instructions as given.I will inform my practitioner of any new medications, conditions, or treatments before each session.I understand the cancellation/no-show policy.

I have read and agree to the studio's policies and consent to treatment.Type your full name as your signature *

Your information is private and only visible to your practitioner.

Intake form — Euphoria Electrology · Solia Pro