Online Consultation Form

We are looking forward to seeing you at your upcoming appointment. Please take a moment to fill out the below form prior to your appointment with us.

 
Name *
Name
Check any and all that apply to you.
Do you experience digestive issues? Check all that apply.
LADIES
Transactional Emails *
You can opt to receive emails to keep you informed of new bookings, changes to your bookings, and reminders for upcoming appointments.
News and Special Promotions *
FULL INTAKE FORM - CONSENTS
Full Disclosure Agreement *
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.
Cancellation Policy *
All appointments must be paid for at the time of booking. We require at least 24 hours’ notice in event that you need to cancel or reschedule your appointment. A full refund will be issued for a cancelled appointment in the same method that was used to pay for the appointment. If the appointment is rescheduled with at least 24 hours’ notice, the payment will transfer to the new appointment. If an appointment is missed, cancelled or changed without 24 hours’ notice, the payment is not eligible for a refund, and cannot be transferred to any future appointments. Any late arrival will shorten your appointment time and cannot be made up by running into the next client’s scheduled appointment. We allow a 20-minute grace period. After 20 minutes, the appointment is considered missed and you will forfeit payment.