• CLIENT INTAKE FORM & PROFILE

    Please complete this new client form. Fields should be optional unless the source document clearly marks them required. We use a system called Salonbridge to do our bookings, and therefore require all required fields to be completed in order to book you in. ALL INFORMATION IS PRIVATE AND WILL NOT BE SHARED WITH ANYONE.

  • Personal Information

  • Date of birth required to verify your age for intimate services.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred Payment Type

  • Emergency Contact

    Optional
  • Format: (000) 000-0000.

  • Questionnaire – Health & Medical

    Do You Have Any Of The Following Conditions
  • Eczema*
  • Psoriasis*
  • Dermatitis*
  • Rosacea*
  • Varicose Veins*
  • Diabetes*
  • Epilepsy*
  • Cancer*
  • HIV / AIDS*
  • Lupus*

  • Questionnaire – Medication

    Are You Taking Any Of The Following Medications ?
  • Antibiotics*
  • Hormone Replacements*
  • Acne Medications*
  • Chronic Medication*

  • Questionnaire – Topical Creams

    Are You Using Any Of The Following Topical Creams
  • Retinol*
  • Accutane*
  • Steroids*
  • Other topical creams*

  • Questionnaire – Allergies

    Do You Have Any Allergies
  • Allergies*

  • Skin Sensitivity & History

  • Do you consider your skin sensitive (hypersensitive)?
  • Have you had recent sun exposure, tanning, or sunburn in the last 24–48 hours?*

  • Skin & Grooming Profile

  • Service Selection

    Please select all option relevant to your requested treatment options
  • Type a question

  • Client Preferences

  • Consent & Communication

  • May we contact you regarding appointments and promotions?*
  • Preferred method of contact*

  • Acknowledgement

  • Acknowledgement*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • SIGNATURE

    To Be Signed at The Beginning of Your Treatment
  • Should be Empty: