New Client Profile

New Client Profile

Your privacy is very important. The following information is only used to stay in better contact with you.
Full Name*

First Last
Birthdate:
ex. 01/05/1960
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
E-mail*
ONLY used for updated information and appointment info.
What is the best way to contact you?*

Phone callEmailTextAll
How did you hear about me?

GoogleFacebookInstagramFriend ReferalTown LinkOther
If your answer in the last question was REFERAL please give the name.
To cancel an appointment, please do so at least 24 hours prior to your appointment. Any appointment canceled less than 24hrs in advanced will result in a 50% of full scheduled service price. This fee is due prior to rescheduling any other appointment.*

I understand the cancellation policy.
I understand, life gets crazy, and things happen. However, if I have not herd from you within 15 minutes after your scheduled time it will be considered a No Show and you will be charged 75% of the full scheduled service price. This fee is due prior to rescheduling any other appointment.*

I understand the No Show policy.
Date*

MonthDayYear
Signature*
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