NEW CLIENT WAITLIST

NEW CLIENT WAITLIST
All new clients start with a skin consultation to help us better understand your skin goals, concerns, and current routine. This allows us to create a customized home care plan designed to treat the skin at home, support long-term results, and prepare your skin for future treatments.

• Virtual or In-Person Consult: $129 Consultation Fee + Product Cost
After completing a thorough consultation where we will identify your environment and lifestyle triggers affecting your skin, we’ll curate a personalized home regimen that will begin prepping, correcting, and targeting your skin for 4-6weeks.

We then will curate a treatment plan in alignment with your timeline & prebook you in for your first treatment that will take place in 4-6 weeks from our initial consultation for those wanting in person treatments

Homecare is a necessary part of the process and will continue to support your results between treatments, AND maintain your results after!

I've noticed in my practice that clients who invest in the home care up front noticeably achieve their results faster compared to those who trickle in a couple of products at each appointment, please let me know what budget you would like me to keep within and I'll do my best to maximize!

I totally understand that investing in new products can be extremely nerve wrecking when you feel like you've tried a lot on the market, but I hope that the before & after photos of my clients can instill some confidence and excitement for this process!

If it ever comes down to 3 treatments or home care, I would prioritize homecare as it will treat your skin morning and night which is 60 times in a month vs coming in 1x/ month for a treatment!
Client Name

First NameLast Name
Date of birth

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Date
Shipping Address

Street Address

Street Address Line 2

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Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
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How did you hear about Moeur Wellness? (Instagram, Tik Tok, Family, Friend, etc. Please state the name of who referred you)
Please upload photos of your skin (center, left/right cheek, and left/ right jaw)

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Please take a moment to answer the following questions

What are your current skin concerns?

Rows	Please select
Hydration
Acne
Aging
Texture
PIH/ PIE
Pore Size
Scarring
Sunburn
Elasticity
Sun Damage/ Melasma

What skin care products do you currently use? (please list brands if possible)

Rows	AM	PM	Weekly
Cleanser
Toner
Serum
Moisturizer
Sunscreen
Exfoliator
Masks
Spot Treatment

To get started on your skincare journey, which type of consultation are you interested in booking?
What is your goal in working with an Esthetician?
What services are you interested in receiving after our initial consultation?
Have you worked or are currently working with a dermatologist?
Have you ever had an adverse reaction from a product, ingredient, or treatment on your face? (If yes, please elaborate on how and where it presented in the skin)
Have you used Dermatologist prescribed topicals or medications, Retin-A, Renova, Adapa-lene, Accutane, Differen, or acids (AHAs or BHAs)? Please specify
Do you have any allergies to cosmetics, food, or drug?
Are you pregnant, nursing, or trying to conceive?
Do you use birth control pills, shot, or IUD? If so, which kind and how long?
For those who have an active lifestyle, please share what workouts you do along with if you take electrolytes, protein shakes, protein bars, or any supplements?
Please list any medications, vitamins, or supplements you take:
Is there a special occasion or certain reason you’re eager to get in as soon as possible/ before a certain date?
Please provide a FEW preferred dates, times, and day of the weeks you prefer or are most flexible
Are you okay with photos/videos being posted of your service?
What inspired you to seek professional skincare treatments at this time?

Other
Now that we have a good foundation and understanding of your goals, feel free to use this next space to further elaborate any goals, concerns, or history if needed:
New client appointments are accepted in waitlist entry order and do not currently have estimated wait times.

You will be contacted by Moeur Wellness to schedule when your appointment request has been accepted.

Please email info@moeurwellness.com for any additional questions/concerns!
POLICIES

By agreeing to our policies, you understand that this appointment at Moeur Wellness is reserved exclusively for you and requires a 48 hour notice for cancellation or rescheduling. Canceled or rescheduled appointments within 48 hours will incur a 50% cancellation fee and No-shows will be charged 100% of the service price.
By submitting this form, you acknowledge and agree that this document serves as proof of your consent and participation. Any attempt to dispute the transaction will be met with this evidence, confirming that you have willingly filled out and agreed to the terms stated.
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NEW CLIENT WAITLIST

POLICIES