Skin and Tonic Intake Form
We are so delighted to be working with you! Before your appointment, we want you to get acquainted with us first and ask you a few important questions!

You will be working with a well seasoned licensed esthetician with an extensive background in nutrition. Our licensing does not allow us to perform medical procedures or skin disorder diagnosis. Peels that we are licensed to perform may not go deeper than the epidermis of the skin, which is about .1 millimeters, approximately the thickness of a sheet of paper.

We want our clients to have the best experience as possible and we want to make sure you are comfortable. Please let us know at anytime if you become uncomfortable. We are happy to make adjustments! For example if the steam feels too hot or you may not be warm enough, we can most certainly help. By speaking up, this allows us to give you a better experience!

We want our clients to have a relaxing experience! Your esthetician will consult with you about your treatment and will let you know if the treatment you selected is best for your skin. She will inform you of the products being used to address current skin issues at the beginning of your treatment. We respect and want to give our clients a relaxing service so if at any time you have any questions or comments during your facial please don’t hesitate to ask!

We are not a “hard sell” skin care salon. However if we do have a product that can benefit your skin, we we will check in with you post treatment to see if you would like a product consult.
If you absolutely do not want us to consult you about products please let us know.

Our cancellation/no show policy:
We require a 24 hour notification for all cancellations. If you do not show up for your appointment or don’t cancel within the 24 hour window your card will be charged in full. Please understand this is not a punishment. Without this policy, we could not stay in business. We appreciate your consideration!

Out of respect to the other practitioners servicing clients in our building and to keep our environment peaceful we do not allow children under the age of 12.

Name and Date: *
Your answer
What brings you in today? Is there anything specifically you would like us to address? *
Your answer
I am here for: (please check all that apply *
Required
Are you using accutane, Retin A, prescribed Retin A creams, Adapalene, Tretinoin, Obagi (do not answer yes if you are using an over the counter retinoid or retinol) *
Required
Have you had any allergic reactions to any products or have any allergies to ingredients that may be in skin care such as nut oils, citrus or other essential oils? If so, please list. *
Your answer
I agree to the 24 hour cancellation and no show policy explained in this intake form! *
Please type your name below as your signature *
Your answer
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