New Client Intake Form 2 | The Skin Enthusiast

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New Client Intake Form

Please take a moment to fill out the form.

First Name

Last Name

Date of Birth 00/00/0000

Gender *

Female

Male

1. How did you hear about The Skin Enthusiast? Google, Instagram, Friend, Family? (please state the name of the person who referred you)

2. Which consultation are you looking to receive? All clients must begin with a consultation to discuss homecare and treatment plan. Consultations are paid by invoice before your consultation is booked. Are you looking for an appointment for in clinic treatment, virtual consultation, virtual acne bootcamp? *

In Clinic Consultation + Treatment

In Clinic Consultation Only

Virtual Consulatation

Virtual Acne Bootcamp

3. Are you looking to make treatments a monthly / regualr thing in order to meet your goals? *

Yes, I am ready for a new home care regimen and to come in for monthly or frequent treatments in clinic.

No, I am just interested in a new home care regimen.

4. How much are you expecting to invest for your home care routine? I carry plenty of products to ensure I can work with almost any budget. My goal is to make sure your results and home care are easily obtainable for you. Keep in mind that a well rounded skin care regimen starts around $175 *

$0 - $175

$175 - $350

$350+

I am willing to invest in whatever you recommend to me to get started on a quality, results driven treatment plan + home care regimen

I am currently on a professional home care routine from my last ethetician and would like help making adjustments.

5. Preferred Date/Time to set up initial consulation. If you don't have a preferrence type " No Preferrence"

Thanks for submitting!

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