New Guest Intake Form

What is your full name*

First Name Last Name

Pronoun

What is your preferred email address?*

example@example.com

What is your current physical mailing address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is your cell phone number?*

Please enter a valid phone number.

What is your Instagram Handle?

If you add your Instagram handle here, I'll follow your account and we can stay connected through the platform

How did you hear about me?*

What is the name of the client who referred you to my business?*

What service are you looking to book for your appointment?*

When is the last time you seen an esthetician?*

How would you describe your skin?*

What are your skin goals?*

Tell me about your diet and water intake.*

Are you taking any medications, supplements or vitamins?*

Tell me about your current regimen.*

What days/times are you available? We will make every effort to get you in as soon as possible in line with the information you enter here. The more available you are, the faster we will be able to get you in.*

Weekdays 9am-12pmWeekdays 12pm-4pmWeeknights 4pm-8pmI will make anything work, I just need to get in ASAP

Is there anything else I should know before booking your appointment?

By completing this form, I am submitting an appointment request and price quote inquiry.In response, I will receive an email/text with an appointment time and date option and a general price quote.

Your appointment in the spa will begin with a 15 minute full consultation to refine the plan for service.

Generally, new guests are able to be seen within 1-2 weeks of appointment submission request, but guests with limited availability may have to wait up to 3-4 weeks to be seen.

Your appointment is very important to me. I hold your time just for you and ask that if you need to cancel or reschedule any appointment, you please provide me with a 48-hour notice. This will allow me to adjust my schedule accordingly to accommodate clients on my waiting list. Failure to notify me before the 48-hour time frame, or to simply not show up, will result in a charge of 100% of the reserved service amount. I ask that you respect my time as much as I respect yours.

By clicking the submit button below, I agree to these terms.

Emergency Contact Name:

First Name Last Name

Emergency Contact Phone Number:

Please enter a valid phone number.

When is your birthday? (I just need the month and day, you can select this year as the year of birth if you'd like)

Date

New Guest Information Form