Client Intake Form
Premier Wax Center & Facial Bar
Client First & Last Name
*
First Name
Last Name
Email
*
Please enter a valid email. By entering your email, we will be able to email you your receipt if you'd like.
Phone Number
*
Please enter a valid phone number. By entering your phone number, we are able to call you and confirm your appointment or call you about any changes if necessary.
Birthday
*
By submitting your birthday, you may receive a $5 discount during your birthday month on an service with a valid ID.
Submit
Should be Empty: