New Resident Intake & Service Request

New Resident Intake & Service Request

Please fill out this form to request an appointment for your loved one. Have details ready for a smooth process.
Location

Resident Name
Preferred Name
Room Number
Birth Date MM/DD
Photo Upload for Referacnce

Cancelof

Previous Salon or Spa Experience
Please share any additional details that would help us serve your loved one better.
Interests/ Triggers/ Professional Career/ Family

Hands & Feet
Select Services
Polish

Facial Hair Services
Select Services

Wellness & Skincare
Select Services

Would you like to set up recurring appointments?
Start Date

MonthDayYear
Date
Preferred Day of the Week
📌We understand how important consistency is for your loved one. Please know that while we make every effort to honor scheduled appointments, the dynamic nature of senior communities may occasionally require us to reschedule or adjust appointment times. We are committed to keeping you informed every step of the way and ensuring your loved one receives the personalized care they deserve.

"📌 Please note: Outstanding balances will result in a pause of recurring services until payment is received."
Method of Payment
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

By submitting this form, you agree to the following terms: Appointments & Scheduling. Appointment times are subject to change based on the needs of our residents and community schedules. All appointments are pending until confirmed by our team. We will notify you of your confirmed appointment using your preferred contact method. Cancellations & Rescheduling We kindly ask for as much notice as possible if you need to cancel or reschedule. This allows us to accommodate other residents in need of services. Recurring Services: Recurring appointments are subject to availability and community access. Outstanding balances will result in a pause of recurring services until payment is received. Payment is due at the time of service. Accepted payment methods include room charge, card, cash, and invoice, where applicable. Authorization: By submitting this form, you confirm that you are authorized to request and approve services on behalf of the resident named above. You also authorize our team to provide the requested services.PrivacyAll information provided on this form is kept strictly confidential and used solely to provide personalized care for your loved one. Photography & Records: Any photos taken during services are strictly for internal record-keeping purposes only and will not be shared, distributed, or used for any other purpose without your prior written consent.Thank you for trusting us with the care of your loved one. We look forward to serving them with the dignity and compassion they deserve.
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