Experience Customization Form

1
Name* This field is required.
First Name
Last Name
2
Do you have outside TIME restraints on your appointment today?* This field is required.
NO
YES
3
What is your time restriction?
4
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
5
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
I'm a little sleepy
Non-talkative
I'm a little sad
Meh
Other
6
COMPLEMENTARY MENU: Time permitting How would you like to ELEVATE your experience today? Some options are ONLY available with a facial.* This field is required.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
7
UPGRADE MENU: Time permitting How would you like to ELEVATE your experience today? 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
Diamond Glow Upgrade $25 for brightening and texture
Oxygen Facial Upgrade $15 for reducing acne and glow
Hydrafacial Upgrade $25 for texture and hydration
Microcurrent $10 for lifting and tightening
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
8
What would you like to drink after your treatment?* This field is required.**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
9
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.
New allergies
ANY New medications?
ANY NEW supplements/ vitamins/ shakes/ etc
You are pregnant
Any physical issues or disabilities
Had filler or botox within 14 days of service, what and when?
Traveling soon
Had any other face procedure or wax done elsewhere within the last month
Do you/have you ever had an allergic reaction to skin care? If so: with me or elsewhere?
ANYTHING NEW WE SHOULD KNOW TODAY?
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?
Possible exposure to M pox?
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
10
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
I'm curious about something new
Cleanser
Toner
AM Serum
PM Serum
Hydrator
Moisturizer
Mask
Acne Med/ BP
Sulfur
SPF
Nothing at the moment
Something else not listed above
11
Do you need any products that wasn't listed. Is there anything else you'd like to share?please type below
12
PLEASE READ!

*LATE ARRIVALS* : If you arrive late, your session may be shortened in order to accommodate others whose appointments follow yours. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible for the "full" session. Out of respect and consideration to your esthetician and other customers, please plan accordingly and be on time.

IF it's an absolute EMERGENCY, OR SAME DAY ISSUES (I left my coat at the clinic, I’m running late, sick less than 36hrs before my apt…) then please TEXT us.

ADD OUR CLINIC APP TO YOUR PHONE HOME PAGE TO ACCESS EVERYTHING EASILY
13
Do you know any one else who’s dealing with acne too?we have a awesome referral program
YESNO
14
Would you be willing to take a quick VIP survey we will give you 10% off your next service for your valuable feed back?* This field is required.
YESNO
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PLEASE READ!