• Skin Care Client Intake Form

    Only required for facials and skin treatments
  • Format: (000) 000-0000.
  • Birthday
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  • How would you describe your skin type? Select all that apply.*
  • What are your primary skin concerns? Select all that apply.*
  • Have you ever received chemical peels, skin resurfacing, laser services, or microdermabrasion?*
  • Have you experienced any hair removal services in the area to be treated in the last 30 days?*
  • Have you used any of the following in the last 30 days?*
  • Have you used any of the following in the past year?*
  • Have you ever used or been prescribed any medications (topical or oral) for acne?*

  • Skincare Routine

    Please specify brand & product names or active ingredients, if you can.
  • Are you experiencing or have you experienced any of the following?*
  • Do you:*
  • If you shave your facial hair: What is your current shaving system?
  • Do you experience irritation from shaving?
  • How would you rate your overall stress level?*
  • Do you take any of the following supplements?
  • Do you have any known allergies?*

  • I understand, have read, and have completed this questionnaire truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I will inform my skin care professional of any changes in my medical history, current medications, and any other relevant changes prior to any future services. The treatments I receive here are voluntary and I release this skin care professional from liability and assume full responsibility thereof.

  • I ask that you please give at least 48 hours notice when canceling or rescheduling. I require a 50% deposit to book services totaling $30 or more.

    If you are a no show, are more than 15 minutes late, or cancel less than 24 hours before your appointment, your deposit will be used to cover your no show/cancellation fee. You will need to provide a new deposit to schedule a new appointment.

    If you cancel with more than 24 hours notice, you will be automatically refunded your deposit. However, please keep in mind that habitual cancellations with less than 48 hours notice may result in you being barred from scheduling future appointments.

    If you reschedule, your deposit is still fully valid and will still go toward the cost of your upcoming appointment. However, please keep in mind that repeated rescheduling with less than 48 hours notice may result in you being barred from scheduling future appointments.

    For appointments totaling less than $30, you will be charged a 50% fee if you are a no show, are 15+ minutes late, or cancel less than 24 hours prior to your scheduled time. This fee will be charged to the card on file. If that card is invalid, the fee will need to be paid before any new appointments can be scheduled.

    For prepaid appointments (such as packages and memberships), please be advised that you are subject to similar policies. Two instances of no shows, being 15+ minutes late, or cancelling with less than 24 hours notice (or any combination thereof) will result in the deduction of one visit from your package or membership accumulations. A third instance, and every single instance thereafter, will result in the deduction of 1 visit from your package or membership accumulations.

    My cancellation policy is in place to ensure everyone who wants to visit is able to. The clients on my waitlist need and deserve reasonable notice of any openings. I am grateful for your understanding and respect for my and each other's time.

  • Photographs: Your skin care professional will take photographs of your skin before and after skin care services. These photographs will be used for documentation purposes within your client file only. With your permission, your skin care professional may use your photographs for educational or promotional purposes. Complete client confidentiality will be maintained at all times.

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