New Client Waitlist

New Client Waitlist

Please fill out this form to be added to our Waitlist. If you'd like to have assistance from us with your skin sooner please see our Virtual options on our website. We look forward to helping you with your skin!
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How did you hear about Lucent Aesthetics?
What are you hoping to achieve by becoming a client of ours? Please be as detailed as you'd like.
Are you currently Pregnant or Breastfeeding?*
Are you currently or have you been on Accutane within the past 12 months?*
Please answer the following questions if you are looking for help with Acne. If this does not apply, please continue below.
How long have you experienced acne for? Tell us a little about your experience with your skin.
Are you currently on prescriptives for acne? If so, please list them here.
Thank you for completing the form. Please submit below.

We will be in touch as soon as we have availability! :)
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