New Client Intake Form

  • New Client Form

  • D.O.B
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  • How did you hear about us?*

  • Your skin type:
  • Does your job and/or lifestyle require that you work/play outdoors?*
  • Is this your first time getting a facial?*
  • Are you currently using any of the following?
  • Do you have any of the below health issues?

  • WHAT IS YOUR MOINING ROUTINE?
  • WHAT IS YOUR EVENING ROUTINE?
  • Are you okay with heat/steam?*
  • Are you claustrophobic?*
  • Do you get anxiety?*

  • Females Only

    males can skip this part
  • Are you pregnant?*
  • Are you planning to get pregnant?*
  • Have you been diagnosed with PCOS?*
  • Have you had a hysterectamy?*

  • Liability Release

  • The treatments I receive are voluntary and I release the company and/or skin care professional from liability

    I (the patient) fully understand all the questions above and have answered them all correctly and honestly. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I understand that the services offered are not a substitute for medical care. I understand that the skin care professional will completely inform me of what to expect in the course of treatment and will recommend adjustments to my regimen if deemed necessary. I also am aware that individual results are dependent upon my age, skin condition, and lifestyle. I agree to actively participate in following appointment schedules and home care procedures to the best of my ability, so that I may obtain maximum effectiveness. In the event that I may have additional questions or concerns regarding my treatment or suggested home product routine, I will inform my skin care professional immediately.

    I release and hold harmless the skin care professional Brianna Hernandez, Pre Skyn, and the staff harmless from any liability for adverse reactions that may result from this treatment.

    If you are not satisfied with your service or products, please contact your skin care professional within 24-hours after your appointment so that the situation may be corrected. It is our policy to provide you with the best professional service and products customized for your skin condition.

  • Todays Date*
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  • Digital consent

  • I authorize Pre Skyn, and staff to take my photographs/video & audio recordings.*
  • I authorize Pre Skyn and staff to use my audio/photos/videos on Facebook, Tiktok, Instagram, social media and any other platforms they may open an account with in the future.*
  • I authorize Pre Skyn and staff to edit, alter, copy or distribute, the audio/photos/videos for education, social media, advertising, and marketing.*

  • Policy

    please read the following and complete with a signature

  • $25 non-refundable deposit is required to schedule your appointment. If you do not send the deposit you do not get an appointment. Deposit will be applied towards your total.

    Forms of payments for deposit,

    Cashapp: $briannahdz06

    Zelle: preskyn22@gmail.com

    Paypal: @preskyn

     

    Reschedule 24hrs before your appointment if you’d like to use that same deposit (this deposit can only be rescheduled once).

     

    If you fail to notify 24hrs before appointment, you will be considered, same day cancellation and you will lose your deposit.

     

    If you do not show up, you will be considered a no show and you will be charged the full service.

     

    If you are running late please notify me. I give a 10 minute grace period. After this grace period you have 2 options lose your deposit or stick with the remaing time and pay the full price. But I do not guarantee the full service since we will be short on time.

     

    I understand we have emergencies and it can somerimes be out off our hands. I can be accomedating where neccesary. All I ask is to have communication with me. If its from my part I will compensate you for the inconvenience. I respect your time, so I ask to plase respect mine and the clients scheduled after you.

     

    If you are not feeling 100% well I ask you to please reschedule.

     

    I understand and agree that I am ultimately responsible for payment in full for services and/or products recieved.

    All sales are final.

    Services & products are not eligible for a refund or exchange. 

     

  • Date*
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  • Should be Empty: