NŪR Wellness Co. | Service Intake & Consent

NŪR Wellness Co. | Service Intake & Consent

This brief intake allows us to prepare for your service with care, ensuring safety, comfort, and a seamless experience tailored to you.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which service are you receiving today?

Other
Have you received this service before?
Lash Services (if applicable)
Do you wear contact lenses?
Have you ever experienced eye sensitivity or irritation?
Have you had a previous allergic reaction to lash adhesive or similar products?
Have you had any recent eye procedures or infections?
Is there anything we should be aware of to ensure your comfort during your lash appointment?
Waxing Services (if applicable)
Have you used retinol or strong exfoliants within the last 7 days?
Are you currently or recently using Accutane?
Do you have sunburn or skin irritation in the treatment area?
Do you have known skin sensitivity or reactions to waxing?
Health & Comfort
Do you have any allergies or sensitivities?
Is there anything else we should know to support your comfort today?
NŪR Wellness Co. assumes no liability for any adverse reactions, sensitivities, or outcomes arising from incomplete disclosure of information or failure to follow aftercare instructions.
This form allows us to provide you with a safe, seamless, and intentional experience. We look forward to caring for you. — NŪR Wellness Co.
Signature
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