Cosmetic Laser New Client Intake

What is your name?*

First NameLast Name

What is your birthdate?*

Date

Phone number*

Email*

example@example.com

How did you hear about us?*

Will you be travelling from outside of Fredericton?

YesNo

How would you best describe your skin type?*

How would you best describe your skin tone?*

Do you currently have a tan?*

YesNo

“My skin concerns include...”*

What are your ultimate skin goals?*

Has your skin felt irritated or had a reaction in anything in the last month?

Please select any of the following that apply to you*

List any cosmetic treatments you've had in the last 4 weeks

Do you have any health conditions or take medications outside of those mentioned above?

Which treatments are you interested in*

What products are you currently using?*

Are you interested in skin care recommendations or samples?*

YesNo

List any allergies

Anything else you'd like us to know?

OUR POLICIES

Child Free Environment Policy

For the safety and comfort of all guests, we kindly ask that children not attend your appointment. Due to the presence of lasers, we strictly enforce a no-children policy in laser-designated areas.

This policy ensures a safe, distraction-free environment for all. We appreciate your cooperation and understanding. If you have any questions, please feel free to contact us.

Cancellations/Rescheduling Policy

For cancellations with less than 24 hours notice, a $25 rescheduling fee sent by e-transfer will be required if you’d like to rebook. For appointments resulting in a no-show, a $50 rescheduling fee is required to rebook.

Once we receive your e-transfer, we'll promptly send over some available appointment options for rescheduling.

We've introduced this policy to help counter a fraction of the loss of income from no-shows and last-minute cancellations, and to encourage greater mindfulness of their impact.

When we don't have time to fill the appointment spot:

It results in lost income.
Clients on our waitlist miss out on the opportunity to receive treatments.

Additionally, rescheduling last-minute means we must allocate another appointment slot, which could have been offered to another client or leads to extended work hours for our team.

Your understanding and cooperation mean the world to us.

This policy is sent to all new clients prior to first visit as well as posted on our reception desk.

*

Cosmetic Laser Intake Form