Model Service Form
**Please only fill out this form if you are comfortable with the session being recorded.** This form is for anyone who wants a free service! 2x per month I will have new or existing clients come in for a recorded session that I can post on social media to market my business. This form is only to show you're interested. If I reach out to you to book the appointment, you still need to fill out a New Client Intake Form or an Existing Client Intake Form. Selections will be as needed in the order they are received with this form. Teen clients must be accompanied by a parent/guardian, and the signature on both forms must be by parent/guardian.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Have you had a facial before?
*
Yes
No
How would you best describe your skin type?
*
Balanced
Dry
Oily
Combination
Do you experience Acne?
*
None or not usually
Mild acne
Moderate acne
Severe acne
Please list your current skin care routine AM/PM. Please include brand names and names of the products.
*
Please list your current skin concerns or skin goals.
*
Please list your availability. *Days of the week and times of the week you are available to come in for a service. This is only used as a reference and does not guarantee an appointment.*
*
I agree that this session will be complimentary and fully recorded.
*
I agree
I agree that audio may be used from conversations during our treatment.
*
I agree
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Should be Empty: