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Let’s Get Started with Your Skincare Journey

Please fill out the form below 👇 to help us understand your skin type, concerns, and skincare goals.

Your skin is unique. This intake form helps us understand your skin concerns, goals and create a customized treatment plan for healthy, radiant skin.

CLIENT INFORMATION

Name

Date

Phone

Address

State

City

Zip:

Email

Date of birth

Occupation:

Male

Female

Other

How did you hear about us?

SKIN HISTORY & CONCERNS

Your main skin goals:

SKIN TYPE & CONDITION

Current Skincare Routine:

Daily

Weekly

None

Products used:

MEDICAL & LIFESTYLE HISTORY

Additional Notes:

SKIN ANALYSIS

Notes from Skin Analysis:

YOUR SKIN PLAN

PRE SKIN TREATMENT

To prepare your skin for the best results:

Thorough skin analysis & consultation

Gentle cleanse

Remove makeup / sunscreen

Double cleanse (if needed)

Skin prep: exfoliation / enzyme / steam

Apply treatment products as recommended

Set goals & confirm treatment plan

SKIN TREATMENT

Your customized facial treatment may include:

POST SKIN TREATMENT

To protect and maintain your results:

Calm and soothe skin (cooling / hydrating)

Apply targeted serums & moisturizer

SPF 30+ (broad spectrum)

Avoid heat, saunas, heavy exercise for 24–48 hours

Avoid harsh products / exfoliants

Keep skin hydrated

Follow homecare regimen

Schedule next appointment

LIRA CLINICAL SKINCARE HOMECARE PRODUCT CHECKLIST

Recommended for your skin type and goals. Use daily as directed.

CLEANSE

Lira Clinical Bio-Barrier Cleanser

Lira Clinical Ultra Cleanser

Lira Clinical Gel Cleanser

TREAT

Lira Clinical PSC (Retinol) Therapeutic Serum

Lira Clinical C and E Essential Serum

Lira Clinical HA Hydrating

MOISTURIZE

Lira Clinical Pro A Corrective Moisturizer

Lira Clinical Ultra Hydrating Cream

Lira Clinical Clear Skin Moisturizer

Lira Clinical Barrier Repair Cream

Lira Clinical Vitamin C Moisturizer

The Mind Beauty Body Skincare

510-890-9553

1375 Sycamore Ave Ste 150A Hercules, CA 94547

SITEMAP

Visitar sitio web en español

Designed By: Profit Specialist Group

510-890-9553Call Us Today

☝️ Click Three Lines above to see the SITEMAP.

Let’s Get Started with Your Skincare Journey

Please fill out the form below 👇 to help us understand your skin type, concerns, and skincare goals.

The Mind Beauty Body Skincare

510-890-9553

1375 Sycamore Ave Ste 150A Hercules, CA 94547

SITEMAP

Designed By: Profit Specialist Group

© 2026 All Rights Reseved

The Mind Beauty Body Skincare

510-890-9553

1375 Sycamore Ave Ste 150A Hercules, CA 94547