Virtual & In-Clinic Consultation - Skin Investment Consent Form

Virtual & In-Clinic Consultation - Skin Consent Form

This consultation is intended for clients who are committed to enhancing their skin health and are ready to invest in a personalized treatment plan tailored to achieve effective results.
Patient Details:
Full Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
What is your current budget for professional-grade skincare products? (Please note that effective skincare requires an investment, and your treatment plan will be tailored to your budget.)
If you qualify for financing, how much are you comfortable spending monthly on skincare and treatments? (Select one)
If your skincare budget is $100/month or less, please make sure to pre-qualify through Cherry, Affirm, Afterpay, or Klarna before booking your consultation.We do not offer personal payment plans at Soulful Essence Artistry you must use one of our partners.If $100/month is your max, financing must be secured through Cherry, Affirm, Afterpay, or Klarna in advance. Otherwise, we won’t be able to move forward with a custom treatment plan, as our plans typically start at $600+.If your financing approval is under $500, you will need to have additional funds available to match your plan, as most treatment programs begin at $600+ If you need the link to apply for Cherry, please reach out to the number directly below.

Questions? Text us at (929) 247-9713
I understand that a $100/month budget must be approved through Cherry, Affirm, Afterpay, or Klarna and will not be accepted directly by Soulful Essence Artistry.
Have you checked to see if you pre-qualify for financing of at least $600+?
Please Read: While some clients may only need professional-grade skincare products to improve their skin.. which typically start around $600. Others may require a combination of products and professional treatments to fully address their concerns. We’ll determine the best plan for you during your consultation, but we recommend pre-qualifying through Cherry, Affirm, Afterpay, Klarna in case your skin requires more than products alone.
I understand that while product plans start at $600+, full treatment plans may reach $2,000–$3,000+ depending on my skin’s needs.
When do you plan to start your skincare journey?
Acknowledgment & Payment Policy
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
I understand that this consultation form includes information about treatment, pricing, results, communication, and usage of any submitted or captured images as outlined above.
Name

First NameLast Name
Date

MonthDayYear
Date
Client Signature

By signing below, I acknowledge that I have read and understand the appointment policy, consent for use of photos/videos, and arbitration agreement outlined above. I agree to abide by these policies and consent to the terms and conditions set forth herein.
Should be Empty:

Virtual & In-Clinic Consultation - Skin Consent Form