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 Name
Last Name
Date of birth
Email
example@example.com
Phone Number
Please enter a valid phone number that is best to contact you.
*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?
Yes I understand and wish to continue booking an appointment
How did you find out about us?
Friend/Family Member Referral (we’ll text you for their name so they can get referral points)
Instagram
Facebook
Twitter
YouTube
Tic Tok
Google
Yelp
What services are you interested in?
Facials: Korean rituals/dermaplaning/monthly maintenance/spa based
Chemical Peel or Face Reality acne bootcamp
Vivant acne/hyperpigmentation/anti-aging program. Formulator of Face Reality
Lumie Aesthetics Bio-Microneedling (100% natural and safe for pregnant woman/breastfeeding/pumping)
Beyond Miracles CELLSTORY Liquid Microneedling Program (100% natural and safe for pregnant woman/breastfeeding/pumping)
KRX Aesthetics Green Sea Peel/liquid needling (100% natural and safe for pregnant woman/breastfeeding/pumping)
Teeth Whitening
Eyebrow Hybrid Henna Stain
Eyebrow Lamination
Eyelash Lift/ plus Tint
Eyelash Extensions (you will be added to a waitlist)
Facial Waxing/other waxing
Do you have sensitive skin?
Yes
No
Not sure
How would you describe your skin currently?
Normal
Normal/Dry
Dry
Dry/Sensitive
Dry/Sensitive/Acne Prone
Combination (Oily & Dry)
Oily
Oily/Active Acne
Oily/Acne Scarring
Normal/Sun Damaged
Dry/Sun Damaged
Dry/Sensitive/Sun Damaged
Combination/Oily/Sun Damaged
Not sure
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:
Yes I understand and give my permissions
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.
60 minute facial ($120)
75 minute facial ($145)
90 minute facial ($170)
120 minute facial ($200)
Lumie Bio-microneedling/liquid needling ($170 single treatment)
Beyond Miracles CELLSTORY liquid needling ($400 single treatment)
KRX Aesthetics Green Sea Peel/liquid needling ($150 single treatment)
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?
Yes
No
Not Sure
Are you interested in learning more about facial memberships & perks?
Yes
No
Not Sure
Select the days and times that you are available. Scroll to the left for Sunday.
Mon
Tue
Wed
Thur
Fri
Sat
Sun
8:00am
9:00am
10:00am
11:00am
12:00am
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
6:00pm
How soon would you like to receive the service(s).
As soon as possible
Next week
In 2 weeks
Next Month
Other
Submit
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