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Facial
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Intake Form

FACIAL

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Information

Date
Month
Day
Year
Birthday
Month
Day
Year
Sex
Male
Female
Women: are you pregnant or lactating?
Yes
No
Men: Do you experience irritation from shaving?
Yes
No

LOCATION

365 East Main Street,

Branford, CT 06405, USA

EMAIL

PHONE

(475) 441-2665

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Copyright © 2024 Serenity Lash bar

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