24/7 VIP Support:
+1-610-467-3455

Adorn Spa and Body Studio

24/7 VIP Support:
+1-610-467-3455

Book an Appointment

Adorn Spa and Body Studio

Personal Information

Full Name *

Patient Age *

Date of Birth *

Phone *

Email Address *

Address Line 1 *

Address Line 2

State *

Postal Code *

City *

Appointment Time *

Appointment Date *

Preferred Reminder Method *

(Text, Email, Phone Call)

Have you booked any other services? *

If yes, please type ' Yes'. If no, type 'No'

Special Requests or Accommodations *

Body Analysis

Body Mass Index

Weight

Body Fat

Muscle Percentage

Body Age

Body Visceral Fat Level

Body Implants

Birth Control

Cosmetic

Electrical Wire

Metal

Hydration Level

1-2 Bottles

3-4 Bottles

5-6 Bottles

More than 7 bottles

Diet Plan

Yes

No

Diet Plan Details

Breakfast Habits

Before 8 AM

Between 8 AM and 10 AM

After 10 AM

Alcohol Consumption

Daily

Weekly

Monthly

Occasionally

Medical History

Do you have Type 1 or Type 2 Diabetes? (Yes/No) *

Yes

No

Write (Type 1 / Type 2) *

(Type 1, Type 2)

Do you have any known liver disease? *

Yes

No

Please Specify Liver Disorder *

Do you have any known kidney disease? *

Yes

No

Please Specify Kidney Disorder *

Do you have photosensitivity to sun exposure? *

Yes

No

Do you currently have cancer? *

Yes

No

Provide medical LOVs *

List of Values (LOVs)

Are you currently on chemotherapy? *

Yes

No

Have you had cancer in the past 12 months? *

Do you have thyroid problems? *

Do you have high blood pressure? *

Do you have any cardiovascular conditions? *

Do you have any medical devices implanted? *

Yes

No

List any implanted medical devices *

e.g., Pacemaker, Hearing Aid, Hormonal Pellets

Exclusion Criteria

Lifestyle and Habits

Do you exercise? *

Yes

No

How often and what type? *

Do you follow any specific diet system? *

Yes

No

Describe the diet system *

Do you eat breakfast? *

Yes, before 8 AM

Yes, between 8 AM and 10 AM

Yes, after 10 AM

How many bottles of water do you drink daily?

1-2 bottles daily

3-4 bottles daily

5-6 bottles daily

More than 8 bottles daily

How often do you consume alcohol? *

Daily

Weekly

Monthly

Occasionally

Skin Care Concerns

What are your specific concerns or challenges with your skin?

Have you had any previous skin treatments?

Yes

No

List the treatments (e.g., Chemical Peels, Microdermabrasion, IPL, Laser, etc.).

Do you experience redness, itching, or stinging on your skin?

Yes

No

Do you have any allergies to skincare products or ingredients?

Yes

No

List the allergens (e.g., Hydroquinone, Glycolic Acid, Retinol, etc.) *

Do you have hyperpigmentation, acne scars, or melasma?

Yes

No

Do you sunbathe or use tanning beds?

Yes

No

Do you have active cold sores?

Yes

No

Current Skin Care Products

Are you currently using any products that contain the following ingredients?

Have you used Retin-A, Renova, Adapalene, or any other prescription skin products within the last three months?

Yes

No

Have you been waxed within the last 72 hours?

Yes

No

Recent Treatments and Procedures

Have you had any of the following treatments within the past 3 months? (Select that apply; if more than one select other and specify...

Please specify

Have you received a cosmetic light-based procedure such as laser treatment, IPL, etc. within the last 6 weeks?

Yes

No

Have you received Botox within the past 2 weeks or other injectable procedures within the past 4 weeks?

Yes

No

Have you received threads within the past two weeks?

Yes

No

Allergies and Sensitivities

Do you have any allergies? *

Yes

No

Please specify the allergens (e.g., Latex, Lidocaine, Skincare Ingredients) *

Have you experienced any adverse reactions to specific skincare ingredients or treatments? *

Yes

No

Are you currently using any medications that cause skin thinning or increased sensitivity? *

Yes

No

Do you experience redness, itching, or stinging on your skin? *

Yes

No

Are you lactose or gluten intolerant, and do you adjust your diet accordingly? *

Yes

No

Target Treatment Areas

Select all that apply. If more than one, choose "Other" and specify.

Please Specify

Advanced Treatment Specifics

What treatment are you having today?

Do you wear contact lenses? *

Yes

No

Do you have sinus problems? *

Yes

No

Within the last year, have you had any health problems that could affect your skin? *

Yes

No

Are you currently using any skin lightening products (e.g., Hydroquinone)? *

Yes

No

Have you received a cosmetic light-based procedure such as laser treatment, IPL, etc. within the last 6 weeks? *

Yes

No

Have you ever experienced claustrophobia? *

Yes

No

Have you received threads within the past two weeks? *

Yes

No

Do you have metal implants, a pacemaker, or body piercings? *

Yes

No

Consent and Acknowledgment

I acknowledge that I have been informed of the nature of the procedure, its risks, and expected outcomes. *

Yes

No

I voluntarily consent to the treatment being performed. *

Yes

No

I understand the potential risks, side effects, and complications associated with my treatment. *

Yes

No

I understand that a minimum of 6-8 treatments may be required to achieve full results. *

Yes

No

I understand that no guarantee has been given regarding the outcome of my treatment. *

Yes

No

I agree to inform my provider immediately if I experience discomfort or wish to stop the treatment. *

Yes

No

I understand that my personal information will remain confidential and will not be shared without my consent. *

Yes

No

I understand that an $85 deposit is required for all skincare and body treatment appointments. This deposit is waived for membership holders and package clients. *

Yes

No

I understand that if my service costs $50 or less, a $45 deposit will be required to secure my appointment. *

Yes

No

Date of Consent *

Digital Signature of the Client *

Clear

Medical Spa in

Chester County

At Adorn Spa, we believe that true beauty is rooted in confidence and overall well-being. Our mission is to help you achieve your aesthetic goals while nurturing your health and vitality. Our cutting-edge medical spa offers a range of treatments and solutions carefully crafted to meet your unique needs. Whether you're looking to revitalize your skin, sculpt your body, or enhance your intimate wellness, our expert team will guide you every step of the way to timeless beauty.

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Malik Medical

Aesthetics & Wellness Center

201 Bridgeton Pike

Mullica Hill, NJ 08062

4.6 Stars from 105 Reviews

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Call Us: 444-444-4444

Text Us: 444-444-4444

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Malik Medical Aesthetics is a premier medical spa, serving New Jersey’s Washington and Harrison Townships with advanced aesthetic and wellness solutions in Chester County

Accessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at 444.444.4444.