New Client Intake Form - Health History
Please answer ALL questions to the best of your abilities before you click submit. I broke it all up into 9 short sections. All information provided will be kept confidential and secure. This information is used to determine contraindications to product/treatment, factors that can impact skin health and to provide customized skin health program recommendations. New Client Intake Form - Confidential Health History. Please complete the Questions to the best of your knowledge.
Email *
First Name *
Middle Name
Last Name *
Today's Date: *
MM
/
DD
/
YYYY
What Type of Skin Care Appointment did you book with us? *
What's the Date of Your Appointment: *
MM
/
DD
/
YYYY
What Time is your Appointment: *
Time
:
SPECIAL NOTE
Please remember to add your appointment date & time to your phone/calendar and set as many reminders as you need. We have a strict 24 hour cancellation policy. Avoid the fee. Learn more by visiting www.LuxuryLotusSpa.com/Policy
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