Skin/Waxing Consultation Form

Skin/Waxing Consultation Form
Name*

First NameLast Name
Pronoun
Zipcode*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you prefer to communicate via text or email?*

TextEmailNo preference
What is your birthday? We just need the month and day, if you don't want to share the year simply enter this year.*

MonthDayYear
Date
How did you hear about us?*
Who referred you?*
What is your Instagram handle?
If you add your Instagram handle here, We'll follow your account and we can stay connected through the platform.
What service(s) are you interested in booking?*

Radiant Beginnings FacialRadiance RitualEssential RadianceCustom FacialBody WaxingFacial Waxing15 Min Shoulder & Neck Massage Add On
What are you interested in waxing?

Full LegHalf LegBrazilianArmUnderarmButtocksStomachChestBack
What are you interested in waxing?

BrowLipChinFull Face
What is your availability? (Waxing)*

Tuesday 9-1Tuesday 1-4Tuesday 3-6Wednesdays 9-11Wednesdays 11-1:30Thursdays 9-1Thursdays 1-4Thursdays 3-6Fridays 9-11Fridays 11-1:30Saturdays 9-12Saturdays 12-3
What is your availability? (Skin)

Wednesdays 12-3Wednesdays 3-7Thursdays 10-1Thursdays 1-4Thursdays 3-6Fridays 10-1Fridays 12-3Saturdays 9-11Saturdays 11-2:30
What concerns you most about the overall appearance of your skin? Check all that apply.*

DehydratedAcneAcne scarringAge spotsMelasmaBlackheadsExcessive facial hairFine lines and wrinklesOily skinRednessUnder eye puffiness/Dark circlesRosaceaSagging skinSun damageTextureLarge poresLoss of lashes or browsDull complexionOther
Are there any other concerns you would like to share with us?
How would you describe your skin?*

DryCombinationOily
How would you describe your stress level?*

LittleModerateHighSevere
History
Are you currently under the care of a Dermatologist or Physician for any ongoing health or skin concern(s)? If yes please elaborate.*
Do you have any allergies to foods, skin care ingredients or medications? If yes, please list and include your reaction.*
Are you currently on any medications topical or oral? If yes please list.*
How do you heal from a scratch, cut or acne break out?*

No scarWhiteBrownRed
Do you have an allergy to latex?*

YesNo
Do you tan in tanning beds or booths?*

YesNo
List your level of activity.*

Very active.Somewhat active.Sedentary.
Have you taken Accutane within the last year?*

YesNo
Are you currently using or have you within the last four weeks used, Retin-A?*

YesNo
When did you last use it?

MonthDayYear
Date
Please check all products you are currently using.*

CleanserTonerSerumExfoliantMoisturizerSPFMaskEye CreamSelf TannerMake UpConcealer
Please list the names of the products you are currently using that you checked above. The more detail the better we can tailor your treatments and home care moving forward. It's important we know what skin care you are using whether you are coming in for a skin treatment, waxing, or lash extensions. Certain products can have a negative impact on your treatment.*
What are your expectations of this treatment, what result are you hoping to achieve?*
Is this for a special occasion, or something you would like to add to your beauty routine?*

This is just a treat.I want to keep it up.
Do you have seasonal allergies?*

YesNo
Do you tend to get ingrown hairs?*

YesNoSeasonally
Do you consider your skin to be sensitive?*

Not at allSomewhatVery
How long do you remain red for after a brow wax?*

An hour4-6 hours6-8+ hoursSometimes it takes a day or two for my skin to return to normal
Please upload three photos of your skin without makeup on. One front facing and one of each side, preferably in natural indirect light. This helps us to ensure we are booking the correct treatment, and it also is a good marker for the beginning of our skin care journey together. *

Cancelof
I understand that this is a new client form, and that an appointment is not guaranteed or reserved upon submitting this form. I understand this form's purpose is to help Kris & Kierst Salon understand my needs and best guide me in booking the proper services for my first visit. The answers I have provided are true and correct to the best of my knowledge. I understand that Kris & Kierst Salon has a strict 48 hour cancellation policy and if I do cancel my appointment with less than 48 hours notice, I may be banned from booking future appointments with the salon. I understand Kris & Kierst Salon will review and respond to this form via email Tuesday-Friday within business hours. By signing and clicking the submit button below, I agree to these terms. We can't wait to meet you!*
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Skin/Waxing Consultation Form

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