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New Patient Paperwork

Multi-line address
How did you hear about us?

The information in this questionnaire is strictly confidential.

By answering these questions, you have enabled the paramedical esthetician to give you the best treatment for your particular skin type.

Are you currently under the care of a dermatologist?
Yes
No
Are you interested in before/after photos to track progress?
Yes
No
Stress Level
Skin Type
Salt Intake
Caffeine intake
Do you smoke?
Are you on hormonal birth control?
Are you pregnant or breastfeeding?
Have you had facial plastic surgery?
Have you ever had an allergic reaction to a product?

Appointments:

All patients are seen by appointment only. Our clinic's answering service is regularly monitored, and we will make every effort to accommodate you as promptly as possible. To help us stay on schedule, please arrive on time. While we aim to adhere to the schedule, occasional delays may occur due to extended treatments or emergencies.


Appointment Cancellation:

If you need to cancel an appointment, please notify us at least 24 hours in advance. Cancellations or reschedules made within 24 hours of the appointment will incur a $50.00 fee. No-call/no-shows will be charged the full service fee. This policy helps us accommodate clients on the waiting list.


Emergencies:

In the event of an emergency, please contact the clinic directly at 310-421-8829. Pleave a message with your name, phone number, and the nature of your call, if we do not pick up.


Payment Policy:

Payment is due at the time of service or when medication/product is administered. We do not carry accounts or allow outstanding balances. We accept Mastercard, Visa, and American Express; cash payments are not accepted at this time.


Photographs:

We typically take a photo of your skin before your first treatment to track your progress. These images will only be used with your consent.


Treatments:

Our facial treatments differ from standard facials offered at beauty salons and spas. They prioritize therapeutic procedures over relaxation and pampering. To streamline treatment efficiency and reduce costs, we omit facial massages, hand treatments, and gown changes, unless necessary for back or chest treatments. Our facial  treatments typically include cleansing, enzyme or glycol exfoliation, extractions, a calming mask, and application of hydrating, anti-inflammatory, or topical medications tailored to skin type, followed by sunscreen. Like any therapy, results are not guaranteed and depend on diligent home care and treatment regularity. Clearing progress also hinges on adherence to provided instructions, with many clients seeing initial results within the first week.


ARBITRATION AGREEMENT:

Patient consents that any controversy between CLEAR SKIN OC and the patient shall be settled by arbitration in accordance with the then-current commercial arbitration rules of the American Arbitration Association, and judgment on the award rendered by the arbitrator(s) may be rendered by any court having jurisdiction thereof. I agree that I will not litigate any controversy against CLEAR SKIN OC before arbitration hearings have been completed. Plaintiff party will bear the costs of arbitration, and prevailing party shall be entitled to recovery of legal and arbitration costs associated with any dispute. The location of the arbitration shall be in San Juan Capistrano, California. Jurisdiction shall be the State of California.

Contact Us

For any question or virtual skincare consultation inquiry, please fill in the form below

Thanks for submitting! We'll be in touch soon.

Our Clinic

Address

2730 Wilshire Blvd Ste 300 Santa Monica CA 90403

Facial Clinic Partners

The information included on this site is for educational purposes only and is not intended to be a substitute for medical advice or treatment by a health care professional.

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