New Client Inquiry

Mukha is a home-based skincare studio, offering services in a calm, private setting from my residence. If you’re comfortable with this kind of environment, I would love to welcome you into my space.* This field is required.

YESNO

Name* This field is required.

First Name

Last Name

Date* This field is required.

Date

Phone Number* This field is required.

Area Code

Phone Number

Email* This field is required.

example@example.com

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Birthday* This field is required.

What is your Instagram handle? * This field is required.(For those that want to be added to Mukha's private instagram story exclusive to clients only)

How did you hear about us?* This field is required.

Are you currently pregnant, nursing, or trying to become pregnant?* This field is required.

Yes, I’m pregnant

Trying to conceive

Yes, I’m nursing

What are your main skin concerns?* This field is required.

Acne

Hyperpigmentation

Scarring

Fine lines and Wrinkles

Dullness

Large Pores

Congestion

Sensitized

Have you had professional skin treatments done before?* This field is required.

YESNO

Are there any medical conditions, allergies, or skincare products we should know about?* This field is required.

What are your skincare goals or what would you like to improve?* This field is required.

Upload a photo (makeup-free if possible)* This field is required.Take a photo of your face in natural lighting- Left side, Right side, Center, and all areas of concern. If you aren't able to upload multiple files, kindly send me a text at (916) 360-0303

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Preferred Appointment Days & Times* This field is required.Please select all days and time windows that would work best for you. This helps us match your availability with the earliest possible appointment.

Monday 10:30 AM – 2:00 PM

Monday 3:00 PM – 5:00 PM

Thursday 10:30 AM – 2:00 PM

Thursday 3:00 PM – 5:00 PM

Friday 10:30 AM – 2:00 PM

Friday 3:00 PM – 5:00 PM

Saturday 9:30 AM – 12:00 PM

Saturday 1:00 PM – 3:00 PM

Other

New Client Inquiry