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Skincare Visit Form
Please fill out this intake so we may fully enhance your visit with us today
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Full Name
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Your answer
Any recent injuries, wounds, surgeries, or cosmetic injections?
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No
Other:
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What improvements would you like to see
Your answer
Currently or in the past 14 days taken or had
*
Antibiotics
Narcotics
Blood Thinners
Retinol-A
Sunburn
Marijana
Retinol/Vitamin A
Chemical Peel
Fillers
Botox
Accutane
Cigarettes
None
Other:
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Would you like to Upgrade your visit today to an Enhanced HydraSkin Facial?
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Yes!
No
Maybe? We'll discuss benefits with you.
Please include these UPhancements with today’s visit: (with availability)
*
Brow Wax $20
Upper Lip Wax $10
Chin Wax $10
Babyfoot Peel $30 +tax
Infinity Massage Chair 30 minutes - $10 'Kneed’ more? Our Infinity Chair will defuse those knots…
Brow Enhancement $30 - Lasting color to minimize your daily makeup routine!
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