RUBIOLOGY METHOD™ CLARITY COACHING INTAKE FORM

RUBIOLOGY METHOD™ CLARITY COACHING INTAKE FORM

With Stephanie Rubi, R.E. 📍Claremont, California |🔗www.therubiology.com | 📸 @rubiologyofficial
🧾Application Overview

Thank you for your interest in the Rubiology Method™ Coaching & Mentorship.

This intake form is required prior to booking your Clarity Coaching Session with Stephanie Rubi R.E.

The Clarity Session is a one-on-one, paid consultation designed to assess where you are in your electrology journey, where you want to go, and what your next best step looks like.

This is not a school, certification, or licensing program.
This is mentorship—built around real experience, real guest care, and real results.

Coaching pathways may include:
• Technique refinement
• Business and growth strategy
• Observational learning
• Mentorship guidance (based on location and licensure)

All recommendations are customized based on your experience level, goals, and legal scope of practice.

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IMPORTANT BEFORE BOOKING

• This intake form must be completed in full before scheduling your Clarity Coaching Session
• The Clarity Session fee is $75 and is non-refundable
• Submission of this form does not guarantee eligibility for all mentorship formats
• In-person or hands-on opportunities are determined based on licensing laws and experience

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WHAT WE FOCUS ON

The Rubiology Method™ is rooted in results-driven electrolysis for all skin tones and hair types, with a strong emphasis on:

• Two-handed technique
• Positioning, posture, and longevity in your career
• Melanin-rich skin and textured hair
• PCOS, hormonal imbalance, and menopause-related growth
• Transgender and gender-diverse care
• Sensitive skin and trauma-informed practices

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WHO THIS IS FOR

• Licensed electrologists wanting to refine and grow
• Individuals exploring electrology as a career path
• Practitioners looking for real mentorship, not fluff
• Those ready to invest in their skill, mindset, and direction

"The most important investment you’ll ever make in this work… is you."
⚖️ LICENSING RESPONSIBILITY
Each state has different requirements for practicing electrology. It is your responsibility to understand and follow the laws in your state or country.

✅ We recommend reviewing your state requirements here:
👉 AEA Licensing Requirements
Have you reviewed your state’s electrology requirements using the link above?
🚨 Please review your state’s electrology requirements before continuing.🚨

You can find the link above under “Check Your State’s Electrology Requirements.”
💬Tell Us About You
Full Legal Name

First NameLast Name
Preferred Name (if different)

First NameLast Name
Chosen Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
City You Practice In (Currently or Plan to)

Street Address

Street Address Line 2

City

Zip Code
State You Practice In (Currently or Plan to)

Street Address

Street Address Line 2

CityState

Zip Code
State you Practice in (double)(Currently or Plan to)
State Category
State of Practice
✅ Your state requires a specific license for electrology.✅

Be sure to meet the training and licensing requirements outlined for your state before applying.
⚠️ Your state does not currently require a specific electrology license⚠️

However, it’s still your responsibility to follow any related state or local regulations (such as business licenses, health department standards, or cosmetology overlap).
Instagram Handle (optional)
TikTok Handle (optional)
Facebook Handle (optional)
How did you hear about Rubiology coaching?
📂Professional Background (Uploads)

To help us understand your current level and ensure we stay aligned with legal and safety standards, please upload any applicable documents below:
Electrology License (if required by your state or county)

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Business License OR proof of working under a licensed business (if applicable)

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Out-of-State Applicants: Documentation of legal ability to practice (if applicable)

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🎯Your Experience
What best describes where you are right now?:

Other
Years of Experience (in applicable)
Years of Experience (If applicable)
Have you ever received coaching or mentorship in electrology or business?
If yes, briefly share your experience
What electrolysis machine do you currently use?
Please include the brand and model you use, and any features you rely on most (no settings required).
What are you struggling with right now?
(Technique, speed, confidence, ingrowns, working with richly melanated skin, business growth, client retention, positioning, etc.)
What do you want to get out of this Clarity Session with Stephanie Rubi R.E.?
Where do you ultimately want to go in your career?
🔍 Loupes (Magnification)
Do you currently use loupes (magnification glasses) during your electrolysis treatments?
Please include the brand, magnification strength (e.g., 2.5x), and any lighting attachments you use.
Magnification (Loupe) Acknowledgment
👁️ Visual Readiness
Do you use or anticipate needing any visual supports (such as glasses, contacts, magnification, or other tools) to comfortably participate in observational or in-person experiences?
Visual Responsibility Acknowledgment
🗓️Coaching Direction & Interest

Coaching may include virtual sessions, business and professional guidance, observational learning, and, where legally permitted, in-person hands-on mentorship. All recommendations are made after your clarity session based on your goals, experience, and legal eligibility.
Which type of support are you most interested in right now? (select all that pply)
Are you open to traveling to Claremont, California if in-person mentorship is recommended?
What level of commitment are you currently open to?
✅Acknowledgment & Agreement
Please review and confirm the following:
💳 Payment & Participation Acknowledgment
Please review and confirm the following:
Signature
Date of Signature

MonthDayYear
Date
💳Final Step: Submit + Pay
To complete your application, you’ll be prompted to submit the $75 non-refundable application fee at the end of this form.
A member of our team will follow up within 10 business days regarding next steps.

✨ We look forward to connecting with you and supporting your journey✨

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