Desire Beauty Studios Client Intake Form
It is our pleasure to service you at Desire beauty. Please fill out the form below. It is recommended to complete this form at the time of booking.
Name
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First Name
Last Name
For the safety of you and our staff, please take a photo of your non expired license of ID. Please do not block out any information. We will never share your information, please review our Privacy Policies listed by clicking the Spa Policies & Condition link above.
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Please list your Emergency contact - include their First/Last Name, Relationship to you, and Phone Number.
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Please list any medications/supplements you are currently taking. Please be as honest as possible as this can and will effect your lash, brow, and or skin service results/retention. If inapplicable, enter N/A.
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Please list any topical medications you are currently applying. For example, Retin-A, Differin, Hydroquinone, Accutane. Please be as honest as possible as this can and will effect your lash, brow, and or skin service results/retention. If inapplicable, enter N/A.
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Please list any and all allergies. For example, if you are allergic to any form of hair dye, you will not be able to be serviced for lash or brow tint. If lash services are booked, and you are allergic to latex, we will need to be properly advised in order to use a latex free lash glue. If inapplicable, enter N/A.
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Are you allergic to any of the following (Please check all that apply):
Acrylate
Latex
Carbon Black
NONE OF THE ABOVE
Please list any surgeries you've had in the past five years. If inapplicable, enter N/A.
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Please check if you've ever suffered from any of the following:
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Eczema
Sunburn
Skin Cancer
Cold Sore
Uncontrolled Epilespy
Blood Borne Viruses
Psoriasis
Conjunctivitis
Recent Scar Tissues
Diabetes
Blood/Circulatory Disorder
Stye
Pink Eye
Moles
Haemophilia
Immune System Disorder
Other
NONE OF THE ABOVE
If any of the above was checked, please list the last time experienced/more information regarding issue. If inapplicable, enter N/A.
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Are you currently pregnant?
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Yes
Not currently, but breast feeding.
No
How would you describe your skin?
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Dry
Oily
Oily, but only in T-zone.
Combination
Submit
Should be Empty: