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Targeted Treatments

Acne scars

Spider Veins

Skin Laxity

Tattoo Removal

Thinning Hair

Nail Fungus

Sun Damage

Fine Lines and Wrinkles

Dull Skin

Tired Hands

Back Acne

Melasma and Hyperpigmentation
Treatments

Hair Removal

Laser Hair Removal

Electrolysis Hair Removal

Skin Care

Signature Facial

Hydrafacial

Teen Facial

Purifying Deep Cleans

Age-Defyer Facial

Injectables

Botox

Fillers

Peels

Hollywood Carbon Peel

PRX Treatment

Perfect Derma Chemical Peel

Laser

Laser Hair Removal

Hollywood Carbon Peel

Spider Vein Laser Treatment

Nail Fungus Laser Treatment

Laser Tattoo Removal

Skin Tag Removal

Body

CoolSculpting / Cryo Sculpting

Scalp Treatment

Permanent Make-up

Back Facial

Hand Treatment

Skin Rejuvenation

Dermaplaning

Microdermabrasion

Microneedling

Morpheus8-RF-Microneedling
Payment Plans
Results
Monthly Specials
Client Intake Form
- Client Intake Form (Prepaid)

Home
Gift Card
Targeted Treatments

Acne scars

Spider Veins

Skin Laxity

Tattoo Removal

Thinning Hair

Nail Fungus

Sun Damage

Fine Lines and Wrinkles

Dull Skin

Tired Hands

Back Acne

Melasma and Hyperpigmentation
Treatments

Hair Removal

Laser Hair Removal

Electrolysis Hair Removal

Skin Care

Signature Facial

Hydrafacial

Teen Facial

Purifying Deep Cleans

Age-Defyer Facial

Injectables

Botox

Fillers

Peels

Hollywood Carbon Peel

PRX Treatment

Perfect Derma Chemical Peel

Laser

Laser Hair Removal

Hollywood Carbon Peel

Spider Vein Laser Treatment

Nail Fungus Laser Treatment

Laser Tattoo Removal

Skin Tag Removal

Body

CoolSculpting / Cryo Sculpting

Scalp Treatment

Permanent Make-up

Back Facial

Hand Treatment

Skin Rejuvenation

Dermaplaning

Microdermabrasion

Microneedling

Morpheus8-RF-Microneedling
Payment Plans
Results
Monthly Specials
Client Intake Form
- Client Intake Form (Prepaid)

Client Intake Form

Client Intake Form

Please provide accurate details to ensure we can deliver the safest and most effective treatments tailored to your skin and health profile.

Please enable JavaScript in your browser to complete this form.

- Step 1 of 4

Treatment *

Referred By

Full name *

Email *

Address *

State *

Zip Code *

Date of Birth *

Phone Number *

Mobile Number *

Emergency Contact Name *

Emergency Contact Mobile Number *

How often do you have facial done? *

Have you ever had a reaction to a facial? *

Describe (Facial Reaction)

Are you currently taking any medications? *

Do you have any allergies? *

Describe (Currently Medications)

Describe (Allergies)

Please select your skin type *

Dry
Oily
Normal
Acne
Other

Describe your skin *

What are you hoping to achieve or get from today’s facial/treatment? *

Which skin products are you using? *

Please select any health condition(s) that applies *

Please list any other health issues not listed above *

Purpose of skin products used *

Are you currently using any of the following *

Consent *

I have elected by my own decision, to have facial / treatment done.
I have read and understood the above information and have given accurate answers to the questions.
I give the Esthetician permission to perform the facial procedure / treatment.
I understand that there are often inherent risks associated with skin care services, and I agree that as a condition for providing this service, I hold this facility, and Esthetician harmless from any problem that may result from this treatment.
I acknowledge that I have received, reviewed, and fully read the Treatment Plan Informed Consent for my procedure ( Laser Treatment / Morpheus8 / Skin Tag Removal ) and all related documentation in full prior to treatment.

I understand the nature of the procedure, including its risks, benefits, limitations, alternatives, and that results may vary based on individual biological or hormonal factors.

I understand that the number of sessions required may vary and that no specific number of sessions has been guaranteed.

I confirm that no other guarantees, warranties, or representations regarding outcomes have been made, and I am not relying on any statements outside of the written consent.

I have had the opportunity to ask questions, all of which have been answered to my satisfaction. I voluntarily elect to proceed with treatment, knowingly assume all inherent and disclosed risks, and understand that this electronic acknowledgment is legally binding and equivalent to a handwritten signature.

Are you at least 18 years old? *

Yes
No

Name *

Kindly type your full name between two forward slashes “/” such as /About Image Med Spa/ *

I (Parent/Guardian's Name) *

Authorize treatment on (client’s name) *

Kindly type your full name between two forward slashes “/” such as /About Image Med Spa/ *

$25.00

Appointment Confirmation Deposit/Promotion Booking.
Cancel/reschedule 24 hours before appointment, otherwise deposit will be forfeited.
To be respectful of everyone’s time, arriving late may result in a shortened appointment.

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A one-stop aesthetic center in northern Virginia led by CIDESCO and ITEC certified professionals. Dedicated to mastery, integrity, and elevated patient care.

Home
Monthly Specials
Payment Plans
Results
Blog

Home
Monthly Specials
Payment Plans
Results
Blog

Membership Plan
Client Intake Form
Gift Cards
Contact Us
Gift Card
FAQs

Membership Plan
Client Intake Form
Gift Cards
Contact Us
Gift Card
FAQs

Our Location

2915 Hunter Mill Rd, #22
Oakton, VA 22124

Direct Contact

703-944-4791

Email Inquiries

contact@aboutimagemedspa.com

Service Hours

Mon-Fri: 9am - 6pm
Sat: By Appointment

We accept CareCredit payment

About Image Med Spa © 2026.