New Client Appointment Request/Consultation form
After you submit your form I will be in contact with information to book an appointment, give a price, a quote, and/or collect deposit! Talk to you soon!
Full Name
*
First Name
Last Name
Contact Number
*
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
State
Zip Code
First time visit?
*
Yes
No
Referred by?
*
N/A if not applicable
Services
*
Custom Facial
Hydro Facial
Microdermabrasion
Custom Peels
BioRePeel
Pro Cell
Add Ons
Dermaplaning
High Frequency
Light Therapy
HydroJelly
Radio Frequency
Oxygen
BioRePeel
Reminder to stop using all retinol products 1 week prior to your appointment.
*
Agree
Questions about the services?
What days work best for you?
*
Monday
Wednesday
Saturday
Sunday
What time works best for you?
*
Morning
Afternoon
Any time
Please list any/all allergies
*
*DEPOSIT REQUIRED* a non-refundable $50 deposit is required to secure your appointment. This fee will go towards your final total. If you cancel/no show this fee is used as your cancelation fee. You may reschedule up to 24 hours prior to your appointment and the deposit will transfer to your new appointment.
*
Agree
Would you like to be notified about promotional services?
Yes
No
Submit
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