Experience Customization Form

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Name* This field is required.
First Name
Last Name
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Cell Phone Number* This field is required.
Area Code
Phone Number
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Is this your 1st visit?
YES
NO
4
Please RSVP to our 10 year anniversary party, Sunday 12/14/2025 1pm - 4pm at The Beez Kneez. Elevated Filipino finger foods from the Sarap Shop, celebration drinks, DJ, & FUN!(so we know how much food to order)
Yes
YES + Guest
NO
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Do you have outside TIME restraints on your appointment today?* This field is required.
NO
YES
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What is your time restriction?
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How are you feeling today?* This field is required.I want your experience to be perfectly tailored throughout our time together today to make it as personalized as possible!
Talkative & Fun
Non-talkative
I'm a little sleepy
I'm a little sad
Other
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For your comfort and safety, please notify your esthetician immediately if you:* This field is required.SCROLL TO SEE ALL OPTIONS and If you have answered "yes" to questions or have checked off signs or symptoms, we may need to reschedule your appointment.
ANY NEW supplements/ vitamins/ shakes/ etc
ANY New medications?
Had filler or botox within 14 days of service, what and when?
Had any other face procedure or wax done elsewhere within the last month
New allergies
You are pregnant
Any physical issues or disabilities
Traveling soon
Possible exposure to M pox?
ANYTHING NEW WE SHOULD KNOW TODAY?
Do you/have you ever had an allergic reaction to skin care? If so: with me or elsewhere?
Someone in my immediate household is under quarantine for possible COVID exposure?
Coronavirus/Covid-19 positive and not yet tested negative Someone in my immediate household is under quarantine for possible COVID exposure?
Someone in my immediate household is under quarantine for possible COVID exposure Have YOU had or had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19 in the last 14 days?
NONE
Other
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How would you like to UPGRADE your appointment today? Time permitting & Availability of some of these services are ONLY available with a clinical facial or certain specialist, and may vary based upon timing/skin condition.* This field is required.SCROLL TO SEE ALL OPTIONS and CHECK ALL THAT APPLY
LED for BODY Aches and Pains $30
Oxygen Facial Upgrade $15 for reducing acne and glow
Cool/Jet Plasma $20 for reducing acne and lifting and tightening
Eye Brow Wax $30 (ONLY Available with Jodi)
Brow Tint $20 (ONLY Available with Jodi)
Lash Lift $125 (ONLY Available with Jodi)
Lash Tint $35 (ONLY Available with Jodi)
Lip Wax $15 (ONLY Available with Jodi)
Nothing extra today thank you
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Are you running low on any products that you need ?* This field is required.SCROLL TO SEE ALL OPTIONS and so we can have them ready for you at your appointment check all that apply
Cleanser
Toner
AM Serum
PM Serum
Dew It All Serum
Hydrabalance
Hydraremedy
Hydrator
Moisturizer
Mask
Acne Med/ BP
Sulfur Spot
SPF
I'm curious about something new
Nothing at the moment
Something else not listed above
Other
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What kind of music do you want to listen to today?SCROLL TO SEE ALL OPTIONS and select ALL that apply
No Preference / Estheticians Choice
Low rider oldies
80's Hits
Binanural Beats
Reggae
Eléctrica Selvática
Frank Sinatra Radio
Classical
LoFi
HipHop Beats
Other
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What would you like to drink after your treatment?**If Available**
Water
Please fill up my water bottle
Hot Tea Caffeinated
Hot Tea Decaf
Sparkling Water
Acne Tea brewed in house Hot
Acne Tea brewed in house Cold
None
Other
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COMPLEMENTARY MENU: Time permitting How would you like to ELEVATE your experience today? Some options are ONLY available with a clinical facial.CHECK ALL THAT APPLY
Discuss Advanced Treatments
Discuss wedding facial prep schedule
Home Care Demo
Weighted Eye Pillow
Neck Stretching Pillow
Heated Neck Wrap
Nothing extra today thank you
Other
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Late arrivals: Your session may be shortened or rescheduled, and you'll be charged the full price. Please arrive on time.

Same-day emergencies? Text us (running late, sudden illness, forgot something at the clinic, etc.)

Add our clinic app to your home screen for easy access to everything.
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Is there anything else you'd like to share?please type below
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Would you be willing to leave us a google review?
Yes
I already did
No
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