New Client Intake Form-Facials

Please fill out this New Client Intake Form so I can gather more information on what you’d like and make booking an appointment convenient for you.

Please allow up to 72 hours to be contacted
Name

First NameLast Name
Date of birth
Email
example@example.com
Phone Number
Please enter a valid phone number that is best to contact you.Format: (000) 000-0000.
*Texting & Telegram is my main form of contact!* Appointments that are not cancelled/rescheduled within the proper notice will result in your 50% deposit not being refunded. No shows will be charged full price. If you text me to reschedule within the proper time frame, this will go towards your next appointment however, if you do not contact me, unfortunately this will not be refunded.*
Cancellations/Rescheduling/Booking—Since I have a 98% membership based business my time is highly valuable. Just as I would respect your time, I expect the same in return. If you decide to book please keep in mind the following: if you book an appointment in order to receive your 50% deposit back if you wish to cancel, you must cancel 7 days prior to your scheduled appointment. If you are past the 7 day mark you have up to 3 days prior your scheduled appointment to reschedule to have this 50% deposit applied to the rescheduled appointment. Upon booking you are required to pay a 50% deposit that is non-refundable if you fail to follow the above appointment requirements. Do you understand these policies and wish to continue booking?
How did you find out about us?
What services are you interested in?
Do you have sensitive skin?
How would you describe your skin currently?
Are you currently using any prescribed creams from a dermatologist such as: Accutane, retin A, retinol or retinoids, or using any product containing active ingredients or acids?
Have you had a facial before, if so how long has it been since you last received one?
If you are going to be receiving a facial or chemical peel that involves your skin shedding, exfoliating or peeling, you understand you must follow the aftercare (post care) instructions given to you. Failure to do so will result in your skin treatment becoming ineffective and is out of my control once you leave the treatment room. Please select below that you understand and give me permission to perform such treatments:
Is this service for anything particular or are you interested in a certain service or working on a certain skin concern?
Are you interested in any other services besides facials or in a membership?
Is there anything you'd like to focus on: skin concern, exfoliation/ extractions (cleaning your pores), or just relaxation?
Are you allergic to any ingredients?
Do you have a skincare routine, if so what products do you use?
Would you like to have aromatherapy, if so which scent(s) do you like?
Please select the service time that you would to receive. These times are made to ensure you can receive the most out of your facial and work with your time availability.
Are you currently pregnant, breast feeding or plan on becoming pregnant anytime soon?
Are you allergic to any ingredients, foods, fabrics, scents or latex? Please list below.
Do you plan on maintaining the service monthly?
Are you interested in learning more about facial memberships & perks?

Select the days and times that you are available. Scroll to the left for Sunday.

Rows	Mon	Tue	Wed	Thur	Fri
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm

How soon would you like to receive the service(s).
Should be Empty:

Please fill out this New Client Intake Form so I can gather more information on what you’d like and make booking an appointment convenient for you.