SKIN HEALTH NEW CLIENT INTAKE FORM (ONCE FILLED OUT PLEASE BOOK YOUR APPOINTMENT) 
HOLISTIC SKIN + STYLE 
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Email *

FULL NAME *
How did you discover Holistic Skin + Style? *
Phone Number *
Address  *
Date of Birth
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Are you looking for in person or virtual help? *
Please describe a brief history of your skin. Share any sensitivities or aversions. *
How would you describe your skin currently?
 *
What is your current skin care routine? What products do you use? *
What do you love about your skin? *
Where would you like to see changes in your skin? (if any)
 *
List any known allergies.  *
Have you had any of the following done in the last 4 months? Select all that apply.
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Required
How would you describe your current diet, digestion/gut microbiome health? *
Required
How would you describe your current stress level? *
Is there anything you'd like me to teach you or discuss while you're here? How can I best be of service to you? *
Policies, Terms + Conditions
  • Inform Holistic Skin + Tonics of any changes to skin, skincare, and health status before future appointments. 
  • The cancellation policy is 48hrs prior to an appointment. If client cancels an appointment with less than 48hrs they will be charged the full amount for that appointment. 
  • All appointments are secured with a credit card on file. 
  • No shows, multiple cancellations/reschedules to appointments will not be allowed to rebook in the future.
Client Acceptance of Policies, Terms + Conditions *
Required
Virtual Signature:  *
Date: *
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