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New Client Invitation Request
New Client Invitation Request
Welcome!  As you know Chakra Esthetics is an Invitation-Only Spa. You're being asked to fill out and submit this REQUIRED form in an effort to make sure we are a good fit. Please answer ALL questions whether they pertain to you or not.  Please be candid or you risk your submission not being accepted.  Response time for Invitations can take 12-72 hours.
New Client Invitation Request
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  • English (US)
  • 1
    Who are you?
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  • 2
    Answer all questions that apply to you
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  • 3
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    • Rwanda
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    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
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    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 4
    (If applicable)
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 5
    No landline numbers please, as your appointment details are sent via text message to your cell phone.
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  • 6
    This is how we communicate with you with appointment confirmations, reminders and questions. (Please check your junk mail and make sure our emails are reaching you).
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  • 7
    This is for our OpticSlim Skin Analysis Machine and our yearly birthday celebration offers.
    -
    Pick a Date
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  • 8
    1) Their Full Name 2) Relationship 3) Their Cell Phone Number
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  • 9
    Some clients are lucky enough to receive a Guest Pass from one of our VIP Clients, so let us know if it's you!!
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  • 10
    If someone referred you, what is their full name so Chakra Esthetics can celebrate them! Or let us know if it was a simple Google search, social media, advertisements, etc...
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  • 11
    Think hard!
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  • 12
    Share your experience here...
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  • 13
    This includes golf, tennis, lifestyle, etc…
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  • 14
    Select all that apply...
    • Adult Acne
    • Breakouts
    • Skin Barrier Issues
    • Blackheads/Whiteheads
    • Excessive Oil/Shine
    • Rosacea
    • Broken Capillaries
    • Redness/Ruddiness
    • Red or Brown Spots
    • Uneven Skin Tone
    • Eye Puffiness
    • Circles Under Eyes
    • Sun Damage
    • Hyperpigmentation
    • Melasma
    • Wrinkles/Fine Lines
    • Dull/Dry Skin
    • Flaky Skin
    • Dehydrated
    • Eczema
    • Milia
    • Dermatitis
    • Other
    • None
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  • 15
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  • 16
    I encourage you to elaborate here. You can upload pictures of your skin if you would like.
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  • 17
    Are you interested in creating real change in your skin AND making a commitment to do so? Or are you just looking for a one-time facial experience? Please be specific and let us know what kind of working relationship you seek.
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  • 18
    READ CAREFULLY: Select 1 skin complexion AND 1 reaction to sun exposure.
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  • 19
    Let us know...
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  • 20
    Select ALL that that apply...
    • Chemical Peels
    • Laser
    • Microdermabrasions
    • Other (please explain at appointment)
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  • 21
    Please stop use of any of these 2 weeks prior to your first visit if you request a wax service be added to your facial.
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  • 22
    Select any that apply...
    • Shaving
    • Waxing
    • Sugaring
    • Electrolysis
    • Tweezing
    • Dermaplane
    • Threading
    • Depilatories
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  • 23
    Please be candid...
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  • 24
    "Brands" will be addressed in the next question.
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  • 25
    PLEASE list brands and item here as this info is CRITICAL in understanding your skins behavior. You can upload pictures if it’s easier. Simply line up your products on a counter and take a picture and upload it here OR bring it with you to your facial.
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  • 26
    Check any that apply...
    • Dehydrated
    • Wrinkles
    • Puffiness
    • Dark Circles
    • No Concerns
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  • 27
    Check any that apply...
    • Dehydrated
    • Cracked
    • Chapped
    • No Concerns
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  • 28
    Check any that apply...
    • Cosmetics
    • Medicine
    • Food
    • Animals
    • Sunscreen
    • Iodine
    • Pollen
    • AHA’s
    • Perfumes
    • Shellfish
    • Latex
    • Aspirin
    • Other (Please elaborate in the next question)
    • None
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  • 29
    Name each and every allergy below as sometimes this can affect upper facial service (if you carry an epipen, please always have one with you for self-assurance).
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  • 30
    Be honest!
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  • 31
    We need to know to understand your skin...
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  • 32

    What SPF brand and strength do you use on your body? *
    How often do you reapply? *

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  • 33
    There are NO judgements at Chakra Esthetics when it come to this topic and your information remains private. Please includes surgeries, fillers, botox, etc., location of injection, and how long ago the procedure was performed.
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  • 34
    Skip this question if you are male
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  • 35
    Skip this questions if you are male
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  • 36

    WOMEN
    Are you pregnant or trying to become pregnant? *
    Are you lactating? *

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  • 37
    Skip this questions if you are a male
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  • 38
    Please explain…
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  • 39
    Wet, electric or do you prefer facial hair?
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  • 40
    Skip this question if you are a female
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  • 41
    Please check all that apply
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  • 42
    Traditionally, a working relationship with a Licensed Esthetician and use of professional skincare is what is required to see an active change in your skin. A one-and-done approach is never a successful way to change the skins condition, as it's taken a long time for your skin to be in its' present condition. You will be asked to commit to regular visits in order to have a successful outcome. Great results take time and commitment on your part (and ours), so a “McDonald’s Mentality” is highly discouraged here at Chakra Esthetics as it’s NOT realistic. Clients that are below the age of active-menopause receive facials every 28-30 days ages 16+. Clients post-menopause over 50, receive facials every 6 weeks based on sluggish hormones and slower skin cellular turnover rate. Our Best Client Ever VIP's have a Rebooking Discount Perk that saves them $10 on every facial AND 10% off retail purchases immediately following their appointment. Our clients are highly communicative and inform (via email & text) - communication makes for a great working relationship. If you are approved and invited, you'll learn more about that program! Let us know if you agree or not with this statement.
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  • 43
    You can upload pictures of your current skincare routine here which we highly advise as clients often "forget" what they use. If you have any issues uploading, simply bring your picture in on your phone at your first appointment. Client usually forget the name of their products during consultations, so this is why we ask to see this information. Another option is to take a picture with your phone and simply text it to (760) 537-1211 and indicate it's from you.
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  • 44
    ALWAYS ARRIVE A FULL 15-MIN BEFORE YOUR APPOINTMENT BEGINS TO CHECK-IN. PLEASE REMAIN IN YOUR VEHICLE AND TEXT MESSAGE YOUR ARRIVAL TO (760) 537-1211.  PLEASE WAIT FOR OUR RESPONSE AS CHAKRA ESTHETICS CHECKS OUT THE CLIENT AHEAD OF YOU. WE WILL LET YOU KNOW WHEN YOU MAY ENTER VIA TEXT MESSAGE.  THANK YOU FOR YOUR UNDERSTANDING AND PATIENCE. PLEASE DO NOT JUST “SHOW UP” WITHOUT AN APPOINTMENT - EVEN FOR PRODUCT PICK UP'S. YOU CAN REQUEST A 15-min PRODUCTS PICK UP APPOINTMENT VIA TEXT MESSAGE AND WE WILL MAKE A 15-MIN RETAIL BLOCK FOR YOU AS THE SCHEDULE ALLOWS. CLICK "YES" IF YOU UNDERSTAND AND AGREE TO THIS POLICY.
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  • 45

    Chakra Esthetics Policies

    REQUIRED READING - DON'T SAY WE NEVER TOLD YOU! 

    LATE ARRIVAL POLICY - Failure to arrive on time for your service will result in its alteration and will lessen its effectiveness. Arriving more than 10 minutes late will result in cancellation of your appointment and the application of a cancellation fee of 100% of the service(s) scheduled. ALWAYS ARRIVE 15 MINUTES BEFORE YOUR APPOINTMENT BEGINS CELL PHONE POLICY - Silenced Phones are required upon your arrival. Phone conversations and sounds during service are not permitted as they affect productivity and impact your providers ability to concentrate and adhere to their appointment schedule.

    DUTY TO INFORM - CHAKRA ESTHETICS takes every necessary precaution prior to and during the commission of your service. CHAKRA ESTHETICS respects your privacy and requests full disclosure of any allergies, medications, conditions or medical procedures that may require her to modify the service as this would be to your benefit and medical wellness.

    CANCELLATION POLICY - The time you schedule is reserved for your exclusive use. When appointments are missed, or cancelled without sufficient notice, often CHAKRA ESTHETICS is unable to fill the vacancy, causing substantial financial impact to the business. Should you need to cancel or reschedule your appointment with CHAKRA ESTHETICS, 48-hour notice is required. Cancellations with less than 48-hours notice or No-Show will result in a charge equal to 100% of the scheduled service(s). The charge(s) will be applied to your online credit/debit card on file. If your card is invalid or inactive, and additional $25 will be assessed and a PayPal invoice will be emailed to be paid upon receipt. You will not be able to rebook until the balance has been paid. The payment information is secured by the booking system and is not visible to anyone.

    SERVICE UPKEEP POLICY - Results-oriented services require upkeep for maximum outcome. It’s highly advised that you follow maintenance and product directions and keep your regularly scheduled appointments. All service and retail sales are final. PRODUCT

    RETURN POLICY - CHAKRA ESTHETICS must be advised of dissatisfaction of a purchased product(s) within 10 days of original purchase. Only exchanges for another product or in-house credit are allowed. Returned products must be unopened. Customers are responsible for postage of returned products and for replacements/exchanged products if applicable. CHAKRA ESTHETICS cannot be held responsible for adverse reactions when products are mixed with your home products.

    NO CHILDREN OR GUESTS POLICY - CHAKRA ESTHETICS provides clients with a calm relaxing atmosphere for those over 18. It is not safe or a suitable environment for children. Clients must make child care arrangements prior to visiting as children are not permitted in the lobby or treatment room. Please DO NOT bring others with you to the spa. This time is about YOU. Clients who arrive with children will be required to reschedule as there are no exceptions to this policy.

    SCOPE OF PRACTICE - California state law prohibits esthetic professionals from diagnosing or treating clients with medical abnormalities. Should CHAKRA ESTHETICS determine that your are ineligible for a service due to a contraindication, we’d be happy to refer you to an appropriate professional if requested. After your condition has been resolved, you are more than welcome to return.

    PHOTOS - All before and after photos are the exclusive property of Chakra Esthetics.  Photos are the spas way to share results with others.  If you prefer they are not used on social media, please let us know.

    RIGHT TO REFUSE SERVICE - CHAKRA ESTHETICS reserves the right to refuse service to anyone and will dismiss disruptive or abusive clients if necessary. No Racism, Homophobia, Transphobia, Xenophobia, Ableism or any oppressive, discriminatory behavior will be tolerated.  Thank you.

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  • 46
    Your signature insures you agree with our policies that you read above and you accept them as a potential client of Chakra Esthetics Day Spa, Inc. Skipping this step will disqualify your application. After signing, make sure to click SUBMIT so that we receive your Application of Consideration. If accepted and sent an invitation, you'll have 30 days in which to make your appointment. We fill quickly and in advance, so if you have any issues booking please reach out by calling (760) 537-1211.
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  • 47
    Be candid as it is IMPORTANT! You must wait 2 weeks to receive a facial after these procedures.
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  • 48
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Application of Consideration for New Clients
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