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The Finesse Welcome Ritual

1 | Intake Forms

2 | Finesse Harmony Method

3 | Before And After the Harmony Method

4 | Skincare basics

Give $200, Get $100

“Because Confidence is better when Shared”

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Welcome to Esthetic Finesse

We’re so glad you’re here! This should only take about 3–4 minutes. Your answers help us create the perfect plan just for you.

First Name

Last Name

Phone Number

Email Address

Your Medical History

Your safety is our top priority. Please answer honestly — this stays confidential.

Are you currently under the care of a physician? If yes please list why.

Yes No

Are you currently on any medications? If yes please list.

Yes No

Are you taking any anti-platelets or anticoagulants?

Yes No

Any known drug, skin, or food allergies? If yes please list.

Yes No

Have you had previous cosmetic injections? If yes what product?

Yes No

Have you ever had a reaction or complication from numbing at the dentist?

Yes No

Do you have any blood disorders? If yes please explain.

Yes No

Do you have any platelet disorders? If yes please explain.

Yes No

Do you have any significant medical disease?

Yes No

Do you have cancer or a personal history of cancer?

Yes No

Have you ever had a cold sore/herpes virus? If yes please list when.

Yes No

Could you be pregnant? or Breastfeeding?

Yes No

Do you smoke?

Yes No

History of Numbing of Extremities, Diabetes, Seizure Disorder, cardiac history, or pacemaker? If yes explain.

Yes No

Pre-existing eyelid Ptosis (drooping)?

Yes No

Allergy to insects/bees? Or history of hives?

Yes No

History of Anaphylaxis?

Yes No

Active Inflammatory Process / Acne / Infection / injury in treatment area?

Yes No

Immunosuppressive Therapy?

Yes No

Are you receiving chemotherapy?

Yes No

Active autoimmune disorders? If yes explain.

Yes No

Preexisting neuropraxia, or severe facial asymmetry?

Yes No

Hypersensitivity to bimatoprost? (ingredient in Latisse)

Yes No

Your Skin Profile

Everyone’s skin is unique. These quick questions help us plan your treatments safely.

1. Do you tend to: (check all that apply)

Bruise easily Hyper-pigment after treatments Scar easily or keloids Heal quickly Not sure

2. Have you been told you may be prone to melasma or pigmentation?

Yes No Not sure

3. Have you been told you may benefit from collagen-stimulating treatments?

Yes No Not sure

4. What is your average daily sun exposure?

Low Moderate High

5. When exposed to sun, how does your skin respond? (Fitzpatrick)

Always burns never tans Burns easily tans minimally Sometimes burns tans uniformly Rarely burns tans easily Rarely burns tans profusely Never burns deeply pigmented

What Brings You In Today?

Tap any images that match areas you’d like to improve.

Flattened/sunken cheeks

Under-eye hollows or dark circles

Lines and wrinkles around nose and mouth

Forehead lines or frown lines

Crow's feet

Thin or aging lips

Jowling or jawline definition

Neck laxity or "tech neck" lines

Overall facial volume loss

Chin projection or profile concerns

Asymmetry

Facial / Trapezius Muscle Slimming

What Are You Interested In?

Check anything that catches your eye — even if you’re just curious. No commitment.

SECTION A — Quick Skin Check

Do you have a skincare routine?

Yes No

Trouble keeping skin hydrated/glowy — flakey/dull?

Yes No

Trouble with pigmentation (brown, red, pale spots)?

Yes No

Concerned with fine lines and crepey skin?

Yes No

Aging and laxity in neck or under eyes?

Yes No

Ever had microneedling as part of skincare?

Yes No

SECTION B — Procedures of Interest

Nasolabial Fold (Smile/Laugh line) Cheek/Midface Volume Jawline Filler Lip Enhancement Under-Eye Treatment Chin Filler Temple Volume Botox / Dysport (Tox) Microneedling Sculptra / Biostimulators Skincare Consultation I'm not sure — expert guidance

SECTION C — Advanced & Wellness

1. Had laser or device treatments before?

Yes No

2. What would you improve with laser?

Sun damage Redness-rosacea Texture-pores Acne scarring Tightening-crepey Curious not sure

3. How much downtime OK?

Same day 2–3 days 5–7 days More if results significant

4. Sun exposure or melasma concerns?

Yes No Not sure

5. Interested in regenerative/collagen?

PRP/PRF Microneedling with growth factors Bio-stimulating Heard about not sure Curious want education Not interested

6. Which outcomes matter most?

Thicker skin Texture-crepey Under-eye quality Long-term collagen Hair-scalp Overall longevity

7. Interested in skin quality over time?

Yes Maybe No

8. Wellness interests?

Weight loss Metabolic health Peptides-longevity Energy-focus IVs-wellness Curious want education Not interested

Your Goals & Approach

Understanding your vision helps us tailor everything to you.

1. Best version of yourself — what changes would make the biggest difference?

Looking refreshed Restoring lost volume Preventing future aging Confident without makeup Consistent routine Addressing something specific

2. How would you describe your approach to aesthetics?

Subtle Noticeable Transformative Brand new to this

3. Where are you on your aesthetic journey?

Just getting started I've done a few things here and there Experienced but looking for the right provider I have a regular routine and want to level up

4. What's motivating your visit today?

A special event or occasion coming up I've been thinking about this for a while and I'm finally doing it I saw something specific I want to address Just exploring what's possible

5. Flexible Payment Options

We offer flexible payment plans so you can get the full results you want. Would you like us to have options ready for you?

Yes, I'd love to see options Maybe, tell me more during my visit Not needed

Almost Done!

Just a few final questions to help us serve you better.

1. How did you hear about Esthetic Finesse?

2. Anything you go elsewhere for that you wish we offered?

3. Want early access or priority scheduling if we expand?

Yes No

4. Anything else for your provider to know?

Pre-Treatment Medical Screening

Required annually as part of your Medical Evaluation / Good Faith Exam per Medical Director protocol.

Which service(s) are you receiving today? (check all that apply)

Neurotoxin (Botox, Dysport, etc.) Dermal Filler Laser-Light (IPL, BBL, LHR) Chemical Peel Microneedling with PDGF IV Therapy Weight Loss-Wellness Sculptra PRF Advanced Biologics Radiesse Other

⚠ Please select at least one service before continuing.

1. Do you have an allergy to any of the following? (check all that apply)

Latex Chlorhexidine (CHG) Adhesives/Tape None of the above

2. Please list all current supplements and OTC medications:

3. Are you taking any of the following supplements? (check all that apply)

Fish Oil Vitamin E Ginkgo Garlic Turmeric None

4. If you are taking blood thinners, which one(s)? (check all that apply)

Aspirin Plavix Eliquis Xarelto Warfarin Other Not applicable

5. Have you received any vaccinations in the last 14 days?

Yes No

6. If you have an autoimmune disorder, are you currently experiencing a flare or exacerbation?

No Yes Not applicable

7a. Do you have any neuromuscular disorder (e.g., myasthenia gravis, ALS, Lambert-Eaton)?

Yes No

7b. Have you had any prior adverse reaction to neurotoxin injections?

Yes No

8a. Have you had any prior complications from dermal filler (e.g., vascular event, granuloma, prolonged swelling)?

Yes No

8b. Have you had any dental procedures in the last 2 weeks?

Yes No

9a. Have you had significant sun exposure, tanning (including spray tan), or sunburn in the last 2–4 weeks?

Yes No

9b. Are you currently taking any photosensitizing medications (e.g., doxycycline, Accutane/isotretinoin)?

Yes No

Microneedling with PDGF

Pre-Treatment Screening

These questions help us ensure your safety and best results. Please answer honestly.

Section 1 — Recent Treatment History

1. When was your last facial treatment (facial, peel, laser, microneedling, etc.)?

2. Have you had microneedling before? If yes, when was your last session?

No Yes

3. Have you had any chemical peels in the last 2–4 weeks?

No Yes ⚠

4. Have you had any laser or IPL treatments in the last 4 weeks?

No Yes ⚠

5. Have you had Botox or filler recently? If yes, where and when?

No Yes

6. Have you had any recent sunburn or excessive sun exposure?

No Yes ⚠

7. When was the last time you waxed, threaded, or used depilatory cream on the treatment area?

Section 2 — Current Topical & Medication Use

1. Are you currently using any prescription topicals (Retin-A, hydroquinone, steroid creams)?

No Yes ⚠

2. Have you used retinol, tretinoin, adapalene, or any vitamin A products in the last 3–5 days?

No Yes ⚠

3. Have you applied self-tanner to the treatment area in the last 7 days?

No Yes ⚠

4. Are you taking Accutane, or have you used it in the past 6–12 months?

No Yes ⚠

5. Are you currently taking any blood thinners, aspirin, ibuprofen, fish oil, or similar?

No Yes ⚠

Section 3 — Key Safety Re-Confirmation

1. Are you currently under the care of a physician for any new conditions?

No Yes

2. Are you currently on any new medications since your last visit?

No Yes

3. Are you taking any anti-platelets or anticoagulants?

No Yes ⚠

4. Could you be pregnant? Or are you breastfeeding?

No Yes ⚠

5. Do you have any active skin infection, acne, cold sore, or injury in the treatment area?

No Yes ⚠

6. Do you have any active autoimmune disorders or are you on immunosuppressive therapy?

No Yes ⚠

7. Do you have any known allergies (drug, skin, or food) — especially to topical anesthetics?

No Yes

8. Have you ever had a reaction or complication from numbing agents (e.g., at the dentist)?

No Yes ⚠

9. Do you have a history of keloid or hypertrophic scarring?

No Yes ⚠

10. Do you have a history of herpes simplex (cold sores) in or near the treatment area?

No Yes ⚠

Section 4 — Skin & Healing Tendencies

1. Do you bruise easily?

No Yes

2. Do you tend to hyper-pigment after treatments?

No Yes Not sure

3. Are you prone to melasma or pigmentation changes?

No Yes Not sure

4. What is your typical healing speed?

Fast Average Slow

Section 5 — Treatment Goals

1. What areas would you like treated today?

2. What are your primary skin concerns or goals for this treatment?

3. Have you had any previous PDGF or regenerative skin treatments? If yes, please describe.

No Yes

Patient Acknowledgement

I certify that the information provided above is true and correct to the best of my knowledge. I understand that withholding or providing inaccurate information may affect my treatment safety and outcomes. I have had the opportunity to ask questions about the microneedling with PDGF procedure, and I understand the potential risks, benefits, and alternatives. I authorize my provider to proceed with the treatment as discussed.

Patient Signature (type full legal name)

Date: April 17, 2026

⚠ Contraindication Detected

One or more answers require provider review before treatment proceeds. The PDF will highlight these in red.

Consent & Signature

Please review and accept the following, then type your full legal name to sign.

I certify that the preceding medical, personal, and skin history statements are true and correct. I am aware that it is my responsibility to inform the doctor or the nurse of my current medical or health conditions and to update this history with each appointment. A current medical history is essential for the caregiver to execute appropriate treatment procedures. I authorize Esthetic Finesse to use my photographs and/or videos for promotional and educational purposes across online platforms. I consent to Esthetic Finesse occasionally recording portions of my visit for internal staff training purposes, with the understanding that all recordings will be kept secure and confidential in accordance with HIPAA guidelines.

Type your full legal name to sign

Date: April 17, 2026

The Referral Program Everyone's Talking About

Invite up to 5 friends you love to experience Esthetic Finesse.
They’ll receive a $200 gift credit to use on any treatment.
You’ll receive $100 per friend once they complete their first visit.
That’s up to $500 in thank-you credits just for sharing the glow.

How It Works

Fill out your name + number in the form on the right side of the screen
Fill out the names + numbers of your 5 friends in the form on the right side of the screen
Push the Send the Glow button and we will send a text to your friend on your behalf

“Hello {Patient Name}! This is Nurse Diane from Esthetic Finesse. Your friend {Referral Name} has generously gifted you a $200 credit to experience our exclusive aesthetic injectable treatments. Ready to indulge in some self-care? Reply YES to claim.”

What Happens Next

You’ll be notified when your friend completes their visit.
Your $100 credit will be added to your account.
You have 90 days to use each thank-you reward.

Quick Reminder

Referrals must be new clients to Esthetic Finesse.
Credits are non-transferable and may not be combined with other offers.

The Finesse Harmony Method

“I don’t just treat features — I restore harmony”

The Finesse Harmony Method™ is a proprietary aesthetic approach I personally created, born from years of clinical experience, artistic intuition, and a deep commitment to natural, beautiful outcomes.

Over time, I realized: we can’t truly enhance one area without understanding how it interacts with the rest of the face. So I designed a method that looks at everything — bone structure, volume shifts, light reflection, symmetry, and proportion. It’s not about chasing trends or fixing isolated areas… it’s about creating soft, lifted elegance that feels like you — just brighter, fresher, more in balance.

This method guides every single consultation and treatment I perform, ensuring:

✓ A fully personalized, whole-face experience
✓ Strategic, staged plans that honor your anatomy
✓ Cohesive, naturally refreshed results that last

It’s not just what I do. It’s how I see beauty — through the lens of harmony.

How does the Finesse Harmony Method work? WHAT TO EXPECT TODAY?

Every face tells a story.

We use an EF Assessment Map and a 0–5 aesthetic scale to guide your treatment plan.

We prioritize treatments based on what your facial structure needs most—volume support, symmetry, or light flow.

Services may include: PRF, PRP, dermal filler, tox, and bio-stimulators.

BEFORE AND AFTER FINESSE HARMONY METHOD

Full Face Tox: Masseter and lower face tox
Midface: Volume restoration and light enhancement
Chin & Chin Shadows: Profile definition and soft transitions
Marionette lines: Support via subcision
Lips: Subtle enhancement for facial balance
Smile lines: Softened
Preauricular: Smoother transitions

BEFORE AND AFTER FINESSE HARMONY METHOD

Areas Treated: Midcheek, smile lines, under-eyes, chin, chin shadows, and lips.
Method: Full-face aesthetic analysis, custom-staged filler + PRF gel plan, precision mapping and implementation.

BEFORE AND AFTER FINESSE HARMONY METHOD

Temples: Minimize shadows and frame the face
Midcheeks: Restore youthful contour (check side profile for volume curve)
Preauricular: Softened harsh cheekbone transitions
Chin & Chin Shadows: Shaped and smoothed
Marionette lines: Support with filler/tox
Lips: hydrated and harmonized

BEFORE AND AFTER FINESSE HARMONY METHOD

PRF gel to localize growth factors for skin stregthening, thickening and overall volumization in undereye, midcheek, and nasal folds.
Filler to soften chin shadows and refine chin shape.

BEFORE AND AFTER FINESSE HARMONY METHOD

Full Face Tox: Brow lifting, wrinkle softening, jawline & lower face lift
Temples: Upper face lift and support
Midcheeks & Preauricular: Restore volume and soften transitions
Chin projection & shadows: Balance facial proportions
Smile lines: softened
Neck: Tightening via subcision with Hyperdilute Radiesse
Lips: Subtle balancing for final harmony

Skincare Importance

“Insurance for your Injectables”

Why medical-grade skincare is essential for your results ?
Injectables build structure — skincare protects and perfects it.
Without proper skincare, your results may fade faster or appear less refined.
Alastin Skincare is clinically proven to boost collagen, improve elasticity, and enhance healing.
Designed to work synergistically with Botox, filler, and PRF.
Helps restore the skin barrier, reduce inflammation, and create a healthier, glowier canvas.
We carry Alastin here in-clinic — ask Nurse Diane if you're unsure where to start.
Even adding one or two key products can dramatically upgrade your results and longevity.

Nurse Diane can’t wait to see you in her chair!

Thank You, !

Nurse Diane can’t wait to see you in her chair. She’s reviewing your responses now. Sit back, relax — we’ll be with you shortly.

Thank You, !

Nurse Diane can’t wait to see you in her chair. She’s reviewing your responses now. Sit back, relax — we’ll be with you shortly.