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Client Intake Questionnaire

Please complete this form at least 2-3 days before your scheduled service appointment!

Medical History

Examples: Retin-A, Accutane (last yr), Antibiotics, Cigarettes, Stimulants, Diuretics, Oral Contraceptives
Laser, Botox, Fillers, etc.


Your Skin & Experiences

Skin Care Routine

For Example, Cleanse: Olay cleanser Tone: Seabreaze Exfoliate: Almond scrub.
If yes, please describe treatment and reaction.
Client signature authorization
Office Use Only. Medical Director Signature


Visit us on Lamar

Just Jill Beauty & Wellness is located on North Lamar behind the Half-Price Books, in beautiful Austin, Texas.

Our Hours

Monday-Thursday: 10AM-7PM
Friday: 10AM-6PM
Saturday-Sunday: 10AM-5PM
No walk-ins - Appointment Only