Skin Care Consultation Form

  • Skin Care Consultation Form

    Eminence Organic Skin Care
  • Format: (000) 000-0000.
  • How did you hear about us?
  • Are you allergic to anything?
  • Have you ever had a facial or skin treatment before?
  • Have you been under the care of a detmatologist?
  • Do you have any permanent cosmetics or tattoos on the areas being treated?
  • Does your skin form Hyperpigmentation (darkening of the skin) or Hypopigmentation (lightening of the skin) or marks after physical trauma?
  • What conditions would you like to improve?
  • Rows
  • Date
     - -

  • By completing this form, I am submitting an appointment request. Your appointment in salon will begin with a 15 minute full consultation to refine the plan for service. Generally, new guests are able to be seen within 2-3 weeks of appointment submission request, but guests with limited availability may have to wait up to 12 weeks to be seen. I understand that we have a strict 24 hour cancellation policy and if I do cancel my appointment with less than 24 hours notice, I may be banned from booking future appointments with the salon. By clicking the submit button below, I agree to these terms.

  • Should be Empty: