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WISH Esthetics Client Intake/Consent Form

WISH Esthetics Client Intake/Consent Form

I am so honored to have the opportunity to grant your skin care WISH. This takes about 5 minutes to complete. and ALL information gathered is kept in strict confidence. Once submitted, you will be directed to my booking page.
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    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
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    • China
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    • Netherlands
    • Netherlands Antilles
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    • New Zealand
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    • Nigeria
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    • Northern Mariana
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    • Oman
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    • 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
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    • South Africa
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    • Spain
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    • 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
    • United States
    • 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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    This communication may be sent via text, email, or mail. Your information is kept private.
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    My lips are sealed.
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    Please discontinue use 7 days prior to your facial service with me.
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    Include prescription and over the counter products.
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    Some topical medications can make skin more sensitive.
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    Select all that apply. All answers are kept in strict confidence. Some medications/procedures may make skin more sensitive.
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    Please note: Facial treatments are not recommended for at least 14 days AFTER injections.
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    Please note: Facial treatments are not recommended for at least 14 days AFTER injections.
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    Select all that apply.
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    Select all that apply
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    Select all that apply.
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    Please refrain from shaving the day of your facial service.
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    Please refrain from shaving the day of your facial service.
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    WISH ESTHETICS POLICIES

    On the day of your appointment, you will receive a text with a Customize Your Experience form. Please complete to allow for the best possible service.

    Cancellation Policy - Please provide a minimum 24-hour notice for rescheduling or cancelling your appointment. If 24-hour notice is not received, a $65 fee may be charged and sent via email invoice. If the time slot is filled, the fee will be happily waived.

    Late Policy - In most cases, accommodations can be made for arriving less than 30 min. late for your appointment. After 30 min., the appointment will need to be rescheduled and a $65 fee may be sent via email invoice.

    Retail Return Policy - If you are not happy with your purchase, please reach out as soon as possible. WISH Esthetics offers a full refund of unused product for 30 days and product less than 25% used within the first 14 days of purchase.

    Service Etiquette - Plan to arrive no sooner than 10 minutes prior to your scheduled time. Text me if you have any issues that require my immediate attention.

    Thank you for honoring these policies.

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    CONSENT


    I understand, have read, and completed this form truthfully. I agree submission of this form constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from services received. The treatments I receive are voluntary and results are not guaranteed. I release WISH Esthetics LLC and/or Kelly Wolcott from liability and assume full responsibility thereof.

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    I have read and understand WISH Esthetics policies.
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