working hours
& contact

Mon – Fri : 10:00 AM – 6:00 PM
Saturday : 10:00 – 4:00
Saturday : Closed

 

679 N Milwaukee Ave, Chicago, IL 60642

Follow Us
Image Alt

Consult Form

Please provide us with detailed information so that it becomes easy for us to identify and comprehend your skin condition and offer you the most suitable treatment when you come to us.


InstagramFacebookGoogleWebsiteYelpReferral


Your Skin

YesNo

I Always burns easily, never tansII Always burns, tans slightlyIII Burns moderately, tans graduallyIV Seldom burns, always tans wellV Rarely burns, deep tanVI Never burns, deeply pigmented

- Acne/Acne Scarring- Aging-Lines/Wrinkles- Age Spots- Blackheads/Whiteheads- Broken Capillaries- Discoloration/Sun Damage- Dryness/Dehydration- Dullness- Eczema- Enlarged Pores- Flakiness- Loss of firmness/sagging- Melasma- Oiliness- Redness/Rosacea- Uneven texture- Other(Please list):

NoYes, within 30 daysYes, within the last 6 months

NoYes

NoYes

NoYes

- Waxing- Sugaring- Electrolysis/Laser- NO

CleanserTonerSerumEye creamDay MoisturizerNight moisturizerExfoliantSPFOther

Your Health

YesNo

YesNo


YesNo

Wear contact lensesHave a pacemakerHave metal implantsNo, not applicable

YesNo

YesNoSometimes

ArthritisAsthmaAuto-Immune DisordersBlood clotting abnormalities/Bleeding problemsDiabetesEasy BruisingEczemaEpilepsy / Seizure DisorderExcessive ScarringFever BlistersFrequent Cold SoresHeadaches / MigrainesHepatitisHeart problemsHerpesHigh Blood pressureHIV/AIDSHormone imbalanceKeloidsLymph nodes removedLupusMetal bone pins or platesPCOSPermanent MakeupPhoto-AllergyPoor circulationPoor healingPsoriasisSkin diseasesSun SensitivityThyroid condtionVaricose veinsNONE (no heath issues at this time).


YesNo

AspirinDairyEssential OilsFragrancesFruitsIodineLatexLidocaineNickelShellfishTree NutsVegetablesOtherNone (No known allergies)

FEMALE CLIENTS

YesNo

YesNo

PHOTO CONSENT & RELEASE

- I give my consent to have ALL photos and videos taken to be shared.- I give my consent to have my photos or videos taken to be shared, BUT please conceal my identity (example: block out eye areas in photos or have photos or videos taken from an angle to hide prominent facial features).- At my request, my photos will remain private and be used for my client chart only.

Yes

24 hour cancel / NO SHOW POLICY

- I have read and accept this Late Policy

M.M. Skin understands that your skin is the most important organ of your body and needs professional care. To help keep it healthy, radiant, and beautiful, M.M. Skin offers a range of skincare treatments. We intimately design each skin treatment to give you the best results. For this purpose, we need detailed information about your skin, skincare regime, and any skin conditions that you may have. Fill in the form given above to book your appointment with our expert esthetician online. Feel free to add any details that you deem necessary for the selection of the right treatment for you.

Bitnami