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The Skin Agency

It is important for your safety to review the following and make sure each item checked is true. This questionnaire leads you to book an appointment, but please keep in mind before your appointment, a medical clearance must be performed by our Nurse Practitioner (for new patients/treatments) to ensure you are a right candidate for the treatment. If you have any questions please contact our office 818-696-2643.

I have not taken any antibiotics, iron supplements or Retin-A in the past 14 days
I am not pregnant or breastfeeding
I have not taken Accutane or immunosuppressants in the past 6 months
I am over 18 years of age
I have not tanned (spray tan, tanning bed, tanning lotion, natural tan) in the past 4 weeks
Laser Hair Removal: No waxing, plucking, threading, electrolysis, or hair removal cream in the past 4 weeks?