Esthetics Intake Form

Booking Form

Please provide your personal information below. Thank you!
Today's Date

MonthDayYear
DateHourMinutesAM/PM Option
First Name*
Please type first name.
Last Name*
Please type last name.
D.O.B. (MM/DD/YYYY)*
Mobile Phone*
Email Address*
example@example.com
Occupation
Esthetics Information
NormalOilyDryCombination
CosmeticsMedicineTopical AnastheticsFoodAnimalsSunscreenDrugsPollenAHAsFragranceLatex
YESNO
If yes, please describe...
YESNO
Date

MonthDayYear
Date
If yes, please specify...
Date

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Consultation $100Powder Brows (no previous work) $550Touch up #1 (within 8-weeks of initial procedure only) $250Touch up #2 (6 months-1 year) $325Touch up #3 (over 1 year) $450Touch up #4 (over 2 years) $550
Updated Policy:
- Cash, Credit Cards, PayPal and Venmo (@wasan-najar) accepted.
- The non refundable booking fee is required at the time of booking to set your appointment. This fee will be credited towards your service.
- Must pay another booking fee if rescheduling within 1-week of appointment date. You will loose the 1st booking fee and it will not be credited to your service.
- If you choose to cancel, no show, or show up more than 15 minutes late to your appointment at any time the booking fee is forfeited.
- Venmo payments: Please make payments to "@wasan-najar."
- PLEASE DO NOT BOOK OR COME TO THE APPOINTMENT IF YOU MAY HAVE BEEN EXPOSED TO COVID/COLD OR HAVE ANY SYMPTOMS WITHIN THE LAST 14 DAYS. RESCHEDULING FEES WILL APPLY.
Client Signature*
My Products
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Booking Fee For New Clients
This booking fee is a non refundable fee to set your appointment. This fee will be credited towards your service. You must give at least 1 month notice for rescheduling or another booking fee will be needed to change your date and the 1st deposit will not be credited towards your service. Any no shows, cancellations, and late shows will loose the booking fee. *If you have previous work done your powder brows service fee is $550. Your balance on the day of service will be $250.

$100.00



Booking Fee For Returning Clients
Non refundable booking fee to set your appointment. This fee will be credited towards your service. If you need to reschedule you must give at least 1 month notice or another booking fee will be applied to change your date and the 1st deposit will not be credited towards your service.

$100.00



Consultation
Non refundable booking fee to set your appointment. This fee will be credited towards your service. If you need to reschedule you must give at least 1 month notice or another booking fee will be applied to change your date and the 1st booking fee will not be credited towards your service.

$100.00



Total

$0.00

Payment Methods

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Booking Form

Esthetics Information