Beauty Blitz Med Spa

Beauty Blitz Med Spa

Pre-consult and consent form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Service requested
Date of last Tox service

MonthDayYear
Date
With this consent, Beauty Blitz will send you a separate email to access your patient portal. We do require a $50 non-refundable deposit, which will be taken off your total after completion of service.
Signature
Should be Empty: