Bloom Health | History Form

We're excited to help you customize your BH HydraFacial — Have you received a HydraFacial before?

No, I'm a newbie — this is my first time! Yes, and I'm excited for more!

It's best to plan HydraFacial around any recent skin treatments or active skincare problems. Have you recently had any of the following?

HydraFacial is customized according to your skincare goals. Which exclusive BH HydraFacial would you like to receive during your visit?

BH Signature HydraFacial (30 Mins) BH Deluxe HydraFacial (45 Mins) BH Platinum HydraFacial (60 Mins) I'm not sure which BH HydraFacial is best for me – help me decide!

(*BH Signature HydraFacial ($199) includes our exclusive 3-Step protocol to deeply cleanse, extract, and hydrate the skin. BH Deluxe HydraFacial ($250) adds a personalized Booster Serum of your choice and includes specialized LED Light Therapy. BH Platinum HydraFacial ($300) is the ultimate HydraFacial experience, and includes all of the above, with addition of detoxifying Lymphatic Therapy.)

If you chose the BH Deluxe or BH Platinum HydraFacial, which included Booster Serum would you like to receive with your treatment?

BH HydraFacial can be further customized with Facial Add-Ons. Would you like to receive any of the following Facial Add-Ons during your treatment?

Would you like to extend your BH HydraFacial to any other body areas?

After your BH HydraFacial, a professional-grade SPF moisturizer is applied. Which complementary moisturizer would you like applied following your treatment?

Obagi · Soothing Complex, SPF 25 Obagi360 · HydraFactor, SPF 30 iS Clinical · Extreme Protect, SPF 30 SkinMedica · Total Defense + Repair, SPF 34 ZO Skin Health · Sunscreen + Primer, SPF 30 Eminence Organics · Tropical Vanilla Day Cream, SPF 40 I'm not sure which moisturizer I want – help me decide!

HydraFacial works best as a monthly treatment. Have you planned how often you'd like to receive HydraFacial in the next year?

*For savings on BH HydraFacial, ask about membership in BH+, our monthly membership program. BH+ is $99/Month and gets you 1 FREE BH Signature HydraFacial per month and special pricing on the following services and products: Botox ($9/Unit), Dermal Fillers ($100 OFF), Microneedling ($100 OFF), CoolSculpting ($100 OFF/Cycle), Laser Hair Removal (35% OFF), and Skincare (25% OFF). Also included, same day Botox appointments.

Please update us on your skincare routine. What types of skincare products do you use in your usual skincare routine?

Have you used any of the following types of corrective skincare products in the past?

Do you prefer any specific medical grade skincare?

Have you ever had an allergic reaction to any of the following?

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