LIT Aesthetics Intake Form Welcome to LIT Health! In order for us to properly coordinate your aesthetics procedure(s), please complete the following survey questions in full. Thank you! Name(Required) First Last Email(Required) Phone(Required)Do you have any pre-existing medical conditions? Be as exhaustive as you can. If you have a history of myasthenia gravis, ALS, Eaton-Lambert Syndrome, or any progressive muscle weakness disorder, please make that known.(Required)Have you been on any antibiotics within 4 weeks from today? If so, which one(s)?(Required)Are you currently taking any medications? If so, what are they? Specifically list any blood-thinners, anti-inflammatories, supplements such as acai berry, alfalfa, vitamins E and K, Advil, Aleve, aspirin, coumadin, steroids, Xarelto and Eliquis.What are your desired aesthetic goals? This can be for a single procedure or over time working together?(Required)When was the last time you had toxin and/or fillers?(Required)How did you hear about us?NameThis field is for validation purposes and should be left unchanged. "Every individual deserves the opportunity to invest in their health and wellness."
