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Before your visit

Pre-treatment form

A few questions so your treatment is safe and tailored to your skin. Takes about 2 minutes — everything is kept private.

Chemical peels and microneedling work with the surface of your skin, so this quick health check lets Stefani choose the right treatment and strength for you. If anything needs a closer look, she'll simply have a chat with you before your appointment.

Section 1

About you

Section 2

Your skin

Helps shape your treatment plan.

Section 3

Health & safety

Please answer honestly — this keeps your treatment safe. A "yes" doesn't always rule a treatment out; it just means Stefani will check a couple of things first.

Are you pregnant, trying to conceive, or breastfeeding?
Have you taken Roaccutane / isotretinoin in the last 12 months?
Are you currently using retinol, tretinoin or Differin?
Any history of keloid or raised (hypertrophic) scarring?
History of cold sores / facial herpes?
Any active skin infection, open wound, sunburn or breakout in the treatment area right now?
Do you have diabetes, an autoimmune condition, immune suppression, or a bleeding/clotting disorder (or take blood thinners)?
Thanks for letting us know. This doesn't necessarily mean you can't be treated — Stefani will just confirm a couple of details with you before your appointment.

Section 4

Recent treatments & sun

Active tan, sunbed or fake tan in the last 2 weeks?

Section 5

A little more

Do you smoke?

Section 6

Consent

Thank you

Your form is with Stefani — that's everything sorted before your visit.

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