LexiSkinCo Consultation & Consent Form
Please complete this form and sign before your appointment. This ensures a safe, personalized experience. If you have any questions, don't hesitate to reach out. I can't wait to have you in my chair!
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Appointment
*
-
Month
-
Day
Year
Date
Are you currently pregnant or nursing?
*
Yes
No
Do you have any allergies or sensitivities?
*
Yes
No
If yes, please list your allergies or sensitivities.
Are you currently using any medications or skincare products?
*
Yes
No
If yes, please specify your medications or skincare products ( Retinol, Tretinoin, Accutane, etc. )
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Cancellation Policy Form
Appointments canceled or rescheduled with less than 24 hours' notice will incur a 50% cancellation fee. No shows will also be charged 50% of the scheduled service. by signing below, you acknowledge and agree to this policy.
Signature
*
Submit
Submit
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