FACIAL & TREATMENT INTAKE
59 E Queen
(Call/Text: 509~201~8664) intertribalbeauty@gmail.com)
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First Name *
Last Name *
Phone Number w / area code *
Address-City-State-Zip *
May I add you to my email list? *
Email Address
Date of birth (month / day only) *
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Emergency Contact (Name & Number) *
How did you find me or who can I thank for the referral? 🙏🏽 *
May I take before and after pictures & videos for evaluation and marketing on social media? *
How would you describe your skin?
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What are your main skincare concerns? If you could wave a magic wand, how would your skin look/feel in one month? *
Knowing that home care is 80% of achieving beautiful skin, would you like to chat about how to maintain your results? *
What facial massage pressure do you prefer? *
Please let me know all the aromas you prefer?
What is your favorite color or color scheme? *
Medical, Health, Bodily Conditions: Is there anything I need to know before we start? (Please List: allergies to fruit, food, aspirin, nuts, cosmetics) sensitivities, aversions, pregnant, nursing, diabetes, medications, metal plates, cold sores, herpes, Retin A, Accutane use or any topical products that might cause skin sensitivity. Do you have a condition where you avoid flashing or strobe light? *
Anything else you want to share not mentioned above? *
I completely understand life happens. Please communicate with me beforehand. No Show/Late Cancellation Policy. If you no show for a scheduled appointment, you will be charged 88% of the service fee. If cancellation is made in less than 24-hours of your reservation, you will be charged 50% of the service fee. If you are up to 8 minutes late, your appointment will be shortened and remain the same price, in order for me to provide the client scheduled after you the best possible service. If you are over 8 minutes late, you'll be considered a no show. Please arrive at your appointment time (no early birds🐦). Thank you for understanding! *
I have read and completed this intake questionnaire truthfully. I understand that withholding information or providing false information may result in contraindications and/or irritation to the skin from the treatment(s) received. The treatment(s) I receive are voluntary and I release Inter-Tribal Beauty LLC from any liability. *
Today's Date *
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Electronic Signature (Type Name Below) *
Need The Booking Link? www.octavialewis.com
Shop Clinical Skincare Products: ITB Skincare
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